Abstract, Academic Surgical Congress 2014: See also: http://www.ncbi.nlm.nih.gov/pubmed/25472748 Introduction Stapled gastrointestinal anastomosis has gained wide adoption among the surgical community for its ease, speed, and its applicability in laparoscopic surgery. Over the last decade, anastomotic stapling grew to become the commonplace technique for colon cancer surgery at our center. This abstract assesses whether the increasing adoption of anastomotic stapling affected the rate of anastomotic leaks and duration of surgery. Methods: All patients operated on at our center for colon cancer from 2004 through 2011 were included. Rates of anastomotic leaks were compared between hand-sewn and stapled anastomosis, calculating relative risks and using Fischer's exact test and Chi-square tests to assess for significance. Univariate and multivariate linear regression compared durations of surgery, with estimates of difference were expressed in minutes through the unstandardized B-coefficient. Results: A total of 1071 patients were included. The number of stapled anastomoses grew significantly from 31.6% in 2004 to 70.8% in 2011 (p<0.001).><0.001) but eventually significantly shorter (138 vs. 162.2 P=0.005). This difference remained significant after adjustment for ASA classification, procedure type, presence of adhesions and operating surgeon (B=28.0 minutes; 95%CI 12.2,43.8; P=0.001). Conclusion Stapled anastomoses did not increase anastomotic leak rates. If anything, leak rates appeared slightly lower. In addition, stapled anastomoses significantly shortened operation duration. With the benefit of being a tool that facilitates minimally invasive surgery, it is a safe way to improve efficiency, reduce costs and promotes faster and better recovery.

1. Effect of Transition to Stapled
Anastomosis on Anastomotic Leak Rates
and Operating Times in Colon Cancer
Surgery
Ramzi Amri,1,2
Liliana G Bordeianou,1,2
Patricia Sylla,1,2
David L Berger 1,2
1
Massachusetts General Hospital, Division of General and Gastrointestinal Surgery.
2
Harvard Medical School, Department of Surgery.
02/05/15
9th
Annual Academic Surgical Congress, February 4-6 2014
Integrated Quick Shot Session I: Oncology 3: Colorectal (10.11)

2. Introduction
• Stapled GI anastomosis: easy, fast and safe
• Laparoscopy has gained wide adoption
• Stapling is a great tool for small port surgery
• Growing adoption for CRC at MGH
Did this affect:
• Complication rates?
• Outcomes?

3. Methods
• Colon cancer surgeries at MGH (2004-11)
• Patients with primary anastomosis
(n=998)
• Hand-sewn vs. stapled techniques
• 2004-2007 vs. 2008-2011

4. Results
NS: BMI, obesity, Charlson comorbidity
Stapled Hand-sewn P-value
N (%)
Total 622 (62.3%) 376 (37.7%)
-2004-2007 238 (45.8%)
***
282 (54.2%)
***
2008-2011 384 (80.3%) 94 (19.7%)
Age (median)
Total 66 68 0.028
2004-2007 66 68 0.13
2008-2011 66 69.5 0.058
Laparoscopic (%)
Total 38.1% 6.7% <0.001
2004-2007 29.8%
**
4.6%
*
<0.001
2008-2011 43.3% 12.8% <0.001
Duration of surgery (M)
Total 139 100 <0.001
2004-2007 147.5
***
94
**
<0.001
2008-2011 124 118.5 0.85

5. Results
Stapled Hand-sewn P-value
N (%)
Total 622 (62.3%) 376 (37.7%)
-2004-2007 238 (45.8%)
***
282 (54.2%)
***
2008-2011 384 (80.3%) 94 (19.7%)
Anastomotic Leak (%)
Total 1.6% 2.4% 0.38
2004-2007 1.7% 2.5% 0.53
2008-2011 1.6% 2.1% 0.70
Delayed bowel function (%)
Total 9.6% 10.9% 0.52
2004-2007 13.0%
*
10.6% 0.40
2008-2011 7.6% 11.7% 0.19
Fascial dehiscence
Total 0.6% 0.8% 1F
2004-2007 0.8% 0.7% 1F
2008-2011 0.5% 1.1% 0.56
Colonic obstruction
Total 0.5% 0.3% 1F
2004-2007 0.8% 0.4% 0.59
F
2008-2011 0.3% 0% 0.85
Stay duration (M)
Total 4 5 0.024
2004-2007 4 5 0.86
2008-2011 4 6 <0.001
30-day readmission (%)
Total 6.4% 9.0% 0.13
2004-2007 6.3% 7.8% 0.66
2008-2011 6.5% 12.8% 0.046
F= Fischer’s exact test

6. Results
Covariates B (95% CI) P
Duration of surgery
2004-2007 vs. 2008-2011
(B=change in minutes)
Stapled
- univariate - -15.8 (-28.8, -2.7) 0.018
Surgeon -5.8 (-18.4, 6.7) 0.36
Laparoscopic -17.3 (-30.5, -4.1) 0.010
Hand-sewn
- univariate - 21.1 (4.7, 37.5) 0.012
Laparoscopic 18.7 (2.1, 35,2) 0.027
Multivisceral 15.8 (0.4, 31.2) 0.044
Covariates OR (95% CI) P
Duration of stay ≤4
days
Stapled vs. hand-sewn
Total
- univariate - 1.44 (1.12-1.87) 0.005
Charlson, Age 1.43 (1.09-1.86) 0.009
Ch. Age. DoS 1.65 (1.24-2.21) 0.001
Ch., Age, Lap. 1.03 (0.78-1.38) 0.83
Ch, Age, Lap, DoS 1.24 (0.91-1.68) 0.17
2008-2011
- univariate - 3.17 (1.91-5.25) <0.001
Ch., Age, Lap. 2.28 (1.33-3.91) 0.003
Ch., Age, Lap, DoS 2.28 (1.23-3.92) 0.003
AJCC: American Joint Committee on Cancer staging (7
th
edition);
Charlson/Ch: The Charlson comorbidity score, adjusted for colon cancer.
DoS: Date of Surgery;

7. Conclusions
In our colon cancer surgery cohort:
•Stapled anastomosis had similar complication
rates (if not better)
•Stapled anastomosis are associated with faster
discharges
•Time-related changes were an important factor to
account for when comparing outcomes and
complications

8. Questions?
Disclosures: None.
Contact:
E: ramzi_amri@harvard.edu
W: hsph.me/ramri