AUTHOR=Zhang L. , Xie Z. , Gong L. , Lv X. 

TITLE=Short- and long-term outcomes of laparoscopic low anterior resection with “dog ear” invagination anastomosis for mid and distal rectal cancer a propensity score matched analysis

JOURNAL=Frontiers in Surgery

VOLUME=Volume 9 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.1038873

DOI=10.3389/fsurg.2022.1038873

ISSN=2296-875X

ABSTRACT=<sec><title>Background</title><p>The lateral intersecting margin (dog-ear) was a weak spot of the double stapled technique (DST), We designed “dog-ear” invagination anastomosis (DAIA), which could eliminate the “dog-ear” in laparoscopic anterior resection.</p></sec><sec><title>Patients and methods</title><p>A total of 202 patients underwent elective curative LLAR + DST (<italic>n</italic> = 143) or LLAR + DAIA (<italic>n</italic> = 59) were enrolled in the study. Propensity score matching (PSM) was used to minimize the adverse effects. The clinical data between LLAR + DST and LLAR + DAIA was compared, and the effect of factors on overall survival (OS) and disease-free survival (DFS) was analyzed.</p></sec><sec><title>Results</title><p>After PSM, 53 pairs of the LLRA + DST and LLRA + DAIA patients were enrolled in the study. The LLRA + DAIA group has a higher level (3.50 ± 1.03 vs. 2.87 ± 1.10, <italic>P</italic> = 0.01) of the anastomosis than that of the LLRA + DST group. Patients in LLAR + DAIA group have a lower incidence of protecting loop ileostomy compared to LLAR + DST group (20.75% vs. 5.66%, <italic>P</italic> &lt; 0.05). The LLRA + DAIA patients presented better rates of LARS compare to LLRA + DST patients at 6 months (major LARS 37.74% (<italic>n</italic> = 20) vs. 67.93% (<italic>n</italic> = 36); <italic>P</italic> = 0.007) and 12 months (major LARS 13.21% (<italic>n</italic> = 7) vs. 20.37% (<italic>n</italic> = 11); <italic>P</italic> = 0.03) after surgery. The OS and DFS rates were similar (<italic>P</italic> &gt; 0.05).</p></sec><sec><title>Conclusion</title><p>Laparoscopic low anterior resection with “dog-ear” invagination anastomosis technique are well-established procedures for patients with low rectal cancer. “Dog-ear” invagination anastomosis technique may reduce the incidence of protecting loop ileostomy and significantly affect LARS score, and demonstrate a positive impact on the quality of life after surgery.</p></sec>