End-to-end anastomosis provides similar quality-of-life, compared with other reconstructive techniques six months following total mesorectal excision: Systematic review and meta-analysis

Sarolta Beáta Kávási; Diana-Elena Iov; Anett Rancz; Ádám Zolcsák; Dániel Sándor Veres; Katalin Lenti; Pál Miheller; Péter Hegyi; Szabolcs Ábrahám

doi:10.1016/j.ejso.2024.108599

End-to-end anastomosis provides similar quality-of-life, compared with other reconstructive techniques six months following total mesorectal excision: Systematic review and meta-analysis

Eur J Surg Oncol. 2024 Oct;50(10):108599. doi: 10.1016/j.ejso.2024.108599. Epub 2024 Aug 10.

Authors

Sarolta Beáta Kávási¹, Diana-Elena Iov², Anett Rancz³, Ádám Zolcsák⁴, Dániel Sándor Veres⁵, Katalin Lenti⁶, Pál Miheller⁷, Péter Hegyi⁸, Szabolcs Ábrahám⁹

Affiliations

¹ Semmelweis University, Centre for Translational Medicine, Tűzoltó street 37-47, 1094, Budapest, Hungary; Toldy Ferenc Hospital, Department of Surgery, Törteli street 1-3, 2700, Cegléd, Hungary. Electronic address: [email protected].
² Semmelweis University, Centre for Translational Medicine, Tűzoltó street 37-47, 1094, Budapest, Hungary; Grigore T. Popa University of Medicine and Pharmacy, Universității street 16, 700115, Iași, Romania. Electronic address: [email protected].
³ Semmelweis University, Centre for Translational Medicine, Tűzoltó street 37-47, 1094, Budapest, Hungary; Semmelweis University, Medical School, Department of Internal Medicine and Hematology, Szentkirályi street 46, 1088, Budapest, Hungary. Electronic address: [email protected].
⁴ Semmelweis University, Centre for Translational Medicine, Tűzoltó street 37-47, 1094, Budapest, Hungary; Semmelweis University, Department of Biophysics and Radiation Biology, Tűzoltó street 37-47, 1094, Budapest, Hungary. Electronic address: [email protected].
⁵ Semmelweis University, Centre for Translational Medicine, Tűzoltó street 37-47, 1094, Budapest, Hungary; Semmelweis University, Department of Biophysics and Radiation Biology, Tűzoltó street 37-47, 1094, Budapest, Hungary. Electronic address: [email protected].
⁶ Semmelweis University, Centre for Translational Medicine, Tűzoltó street 37-47, 1094, Budapest, Hungary; Semmelweis University, Faculty of Health Sciences, Department of Morphology and Physiology, Vas street 17, 1088, Budapest, Hungary. Electronic address: [email protected].
⁷ Semmelweis University, Centre for Translational Medicine, Tűzoltó street 37-47, 1094, Budapest, Hungary; Semmelweis University, Department of Surgery, Transplantation, and Gastroenterology, Üllői street 78, 1082, Budapest, Hungary. Electronic address: [email protected].
⁸ Semmelweis University, Centre for Translational Medicine, Tűzoltó street 37-47, 1094, Budapest, Hungary; University of Pécs, Medical School, Institute for Translational Medicine, Szigeti street 12, 2nd floor, 7624, Pécs, Hungary; Semmelweis University, Institute of Pancreatic Diseases, Tömő street 25-29, 1083, Budapest, Hungary. Electronic address: [email protected].
⁹ Semmelweis University, Centre for Translational Medicine, Tűzoltó street 37-47, 1094, Budapest, Hungary; University of Szeged, Department of Surgery, Semmelweis street 8, 6725, Szeged, Hungary. Electronic address: [email protected].

PMID: 39154431
DOI: 10.1016/j.ejso.2024.108599

Abstract

Colorectal malignancy ranked third globally in cancer incidence with 1.9 million cases and nearly 1 million deaths in 2020. Rectal cancer is primarily treated with total mesorectal excision (TME). This study examines surgical, functional, and quality-of-life (QoL) outcomes for different anastomosis types. Pre-registered on PROSPERO (CRD42022368907), the systematic search on November 8, 2022, covered three databases: MEDLINE (via PubMed), Embase, and Cochrane Central. Randomized controlled trials (RCT) assessing adults post-TME, comparing end-to-end anastomosis (EEA) to colonic J-pouch (CJP) and/or side-to-end anastomosis (SEA) were eligible. 29 studies out of 4459 were included. EEA vs. CJP showed no significant differences in anastomotic leakage (AL) (RR: 1.03; CI: [0.84-1.26]) or mortality (RR: 0.77; CI: [0.30-1.98]). At 12 months, the mean bowel movement difference was 1.59/day (CI: [(-)0.66-3.84]). QoL at six and 12 months was similar (SMD: -0.22; CI: [(-)0.82-0.37]). Compared with SEA, EEA had similar AL ratios (RR: 1.59; CI: [0.54-4.72]) and QoL at six months (SMD: -0.04; CI: [(-)0.66-0.58]). EEA demonstrates surgical efficacy comparable to other techniques. Six months postoperatively, EEA's impact on QoL appears similar to CJP or SEA, irrespective of daily stool frequency.

Keywords: Colorectal anastomosis; LARS; Rectum resection; Straight colorectal anastomosis; low anterior resection.

Publication types

Systematic Review
Meta-Analysis
Review

MeSH terms

Anastomosis, Surgical* / methods
Anastomotic Leak / epidemiology
Colonic Pouches
Humans
Plastic Surgery Procedures / methods
Proctectomy / methods
Quality of Life*
Rectal Neoplasms* / surgery
Rectum / surgery