Transanal transection and single-stapled anastomosis reduces anastomotic leakage risk in rectal cancer surgeryNew data shows safer stitching methods for rectal cancer surgery

BACKGROUND: Although several studies have performed pairwise comparisons of individual anastomotic techniques after total mesorectal excision (TME) for rectal cancer, there is a lack of comprehensive analyses, which simultaneously evaluate multiple techniques. This study aims to perform a systematic review and Bayesian network meta-analysis to compare the various anastomotic methods used after TME. METHODS: This systematic review and Bayesian network meta-analysis included both randomized controlled trials (RCTs) and non-RCTs which evaluated outcomes of various anastomotic techniques in patients with rectal cancer undergoing TME. The techniques assessed included immediate handsewn anastomosis, delayed Turnbull-Cutait anastomosis (TCA), double-stapling technique (DST), and transanal transection and single-stapled (TTSS) anastomosis. The primary outcome was the proportion of anastomotic leakage (AL). Secondary outcomes included overall postoperative morbidity and postoperative anorectal function. RESULTS: A total of 13 studies were included, comprising two RCTs and 11 non-RCTs, with a combined total of 2710 patients. TTSS was associated with a lower proportion of AL as compared to both the DST group (RR: 0.43, 95% CrI: 0.21-0.87) and the immediate handsewn group (RR: 0.35, 95% CrI: 0.13-0.74). TCA was also associated with a significantly lower proportion of AL as compared to the immediate handsewn group (RR: 0.42, 95% CrI: 0.21-0.80). No statistically significant differences were observed between groups regarding overall postoperative morbidity or anorectal function. CONCLUSIONS: The findings of this study suggest that TTSS may be associated with a lower risk of postoperative AL after TME for rectal cancer; however, the certainty of evidence was low, and the findings should be interpreted with caution.