End-to-end versus end-to-side anastomosis for low anterior resection: A systematic review and meta-analysis of randomized controlled trials

McKechnie, Tyler; Sharma, Sahil; Daniel, Ryan; Eskicioglu, Cagla

doi:10.1016/j.surg.2020.12.030

Cited by 21 publications

(19 citation statements)

References 44 publications

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“…While our study did not directly compare outcomes with straight anastomosis, we found STELAR to have a 1.4% anastomotic leak rate. This finding is consistent with a recent large systematic review and meta‐analysis in the surgery literature that found the risk of anastomotic leak was significantly lower in patients undergoing STELAR as compared with straight anastomosis; however, that study did not include surgeries done for gynecologic indications 17 . Kalogera et al report a 1.3% leak rate with straight anastomosis in a gynecologic oncology population, however, this utilized a risk stratification schema and employed routine diversions for patients who met criteria, a total of 35.1% in a cohort of 77 patients 19 .…”

Section: Discussionsupporting

confidence: 90%

“…15 Scores were defined as minor In this cohort, we identified a 2.9% complication rate, including both abscess formation and anastomotic leak, which is on par with previously reported complication rates in the colorectal patient population. 16,17 Although it requires more research with direct comparison rates and long-term outcomes, STELAR may be preferable to straight anastomosis in a gynecologic oncology patient population.…”

Section: Stelar Surgical Techniquementioning

confidence: 99%

“…This finding is consistent with a recent large systematic review and meta-analysis in the surgery literature that found the risk of anastomotic leak was significantly lower in patients undergoing STELAR as compared with straight anastomosis; however, that study did not include surgeries done for gynecologic indications. 17 Kalogera et al report a 1.3% leak rate with straight anastomosis in a gynecologic oncology population, however, this utilized a risk stratification schema and employed routine diversions for patients who met criteria, a total of 35.1% in a cohort of 77 patients. 19 While their study reflected a clinical criterion for diversion similar to those practiced at our institution, only 5.8% of patient's underwent diversion in our study, none of which had a clinical anastomotic leak by time of colostomy take-down.…”

Section: Stelar Surgical Techniquementioning

confidence: 99%

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Side‐to‐end reanastomosis after low‐anterior resection (STELAR): Outcomes, feasibility, and description of procedure performed by a gynecologic oncology service

Khetan

Muderspach

Miller

et al. 2022

Journal of Surgical Oncology

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Background and Objectives: Low anterior rectosigmoid resection for a gynecologic disease is usually performed in concert with other procedures and can result in significant morbidity should anastomotic complication occur. This study examined surgical outcomes of side-to-end reanastomosis after low anterior resection (STELAR) performed by gynecologic oncology service. Methods: This is a case series examining consecutive patients who underwent STELAR for gynecologic indications by a single gynecologic oncology group from 2009 to 2018. Prospectively collected institutional surgical database was searched for STELAR, and standard descriptive statistics were used to describe intraoperative and postoperative complications specific to reanastomosis.Results: A total of 69 women underwent STELAR, with median age and body mass index of 54 years and 24 kg/m 2 , respectively. 63.8% of patients had ovarian cancer and 84.4% had stage III-IV disease. The median estimated blood loss was 875 ml. Four (5.8%) women underwent protective loop colostomy at the time of STELAR.Postoperatively, there was 1 (1.4%) case of abscess formation within 30 days and 1(1.4%) case of anastomotic leak 5 weeks after STELAR that required reoperation and diversion. No cases of fistula were clinically identified. Conclusion:Side-to-end reanastomosis may be a safe and feasible procedure to accomplish low rectosigmoid anastomosis in women with gynecologic disease.

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Section: Discussionsupporting

confidence: 90%

Section: Stelar Surgical Techniquementioning

confidence: 99%

Section: Stelar Surgical Techniquementioning

confidence: 99%

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Side‐to‐end reanastomosis after low‐anterior resection (STELAR): Outcomes, feasibility, and description of procedure performed by a gynecologic oncology service

Khetan

Muderspach

Miller

et al. 2022

Journal of Surgical Oncology

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“…However, it is worth noting that in this study, there was no significant difference in LARS occurrence using end‐to‐side anastomosis or end‐to‐end anastomosis ( p = 0.12). And it is slightly different from the results of a previous meta‐analysis 51 . After consideration, we thought that it was mainly due to the small sample size of patients undergoing end‐to‐side anastomosis (39/342), resulting in insufficient statistical efficiency.…”

Section: Discussioncontrasting

confidence: 72%

“…And it is slightly different from the results of a previous meta‐analysis. 51 After consideration, we thought that it was mainly due to the small sample size of patients undergoing end‐to‐side anastomosis (39/342), resulting in insufficient statistical efficiency.…”

Section: Discussionmentioning

confidence: 99%

Development of prediction model of low anterior resection syndrome for colorectal cancer patients after surgery based on machine‐learning technique

Huang

Lin

et al. 2022

Cancer Medicine

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Background Low anterior resection syndrome (LARS) is a common postoperative complication in patients with colorectal cancer, which seriously affects their postoperative quality of life. At present, the aetiology of LARS is still unclear, but some risk factors have been studied. Accurate prediction and early management of medical intervention are keys to improving the quality of life of such high‐risk patients. Objectives Based on machine‐learning methods, this study used the follow‐up results of postoperative patients with colorectal cancer to develop prediction models for LARS and conducted a comparative analysis between the different models. Methods A total of 382 patients diagnosed with colorectal cancer and undergoing surgery at West China Hospital from April 2017 to December 2020 were retrospectively selected as the development cohort. Logistic regression, support vector machine, decision tree, random forest and artificial neural network algorithms were used to construct the prediction models of the obtained dataset. The models were internally validated using cross‐validation. The area under the curve and Brier score measures were used to evaluate and compare the differentiation and calibration degrees of the models. The sensitivity, specificity, positive predictive value and negative predictive value of the different models were described for clinical use. Results A total of 342 patients were included, the incidence of LARS being 47.4% (162/342) during the six‐month follow‐up. After feature selection, the factors influencing the occurrence of LARS were found to be location, distance, diverting stoma, exsufflation and surgical type. The prediction models based on five machine‐learning methods all showed acceptable performance. Conclusions The five models developed based on the machine‐learning methods showed good prediction performance. However, considering the simplicity of clinical use of the model results, the logistic regression model is most recommended. The clinical applicability of these models will also need to be evaluated with external cohort data.

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A comparison of end-to-end and end-to-side anastomosis following rectosigmoid resection in ovarian cancer cytoreductive surgery

Graham¹,

Kotsopoulos²

2023

European Journal of Surgical Oncology

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End-to-end versus end-to-side anastomosis for low anterior resection: A systematic review and meta-analysis of randomized controlled trials

Cited by 21 publications

References 44 publications

Side‐to‐end reanastomosis after low‐anterior resection (STELAR): Outcomes, feasibility, and description of procedure performed by a gynecologic oncology service

Side‐to‐end reanastomosis after low‐anterior resection (STELAR): Outcomes, feasibility, and description of procedure performed by a gynecologic oncology service

Development of prediction model of low anterior resection syndrome for colorectal cancer patients after surgery based on machine‐learning technique

A comparison of end-to-end and end-to-side anastomosis following rectosigmoid resection in ovarian cancer cytoreductive surgery

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