Use of a Powered Circular Stapler Can Prevent Anastomotic Air Leakage in Robotic Low Anterior Resection for Rectal Cancer.

Objectives: Preventing anastomotic complications during rectal cancer surgery is important. Compared with a manual circular stapler, a powered circular stapler is expected to reduce undesirable tension during anastomosis. However, whether a powered circular stapler can reduce anastomotic complications during robotic low anterior resection (Ro-LAR) remains unclear. We aimed to investigate whether the use of a powered circular stapler contributes to safe anastomosis in Ro-LAR.

Methods: A total of 271 patients who underwent Ro-LAR for rectal cancer between April 2019 and April 2022 were included. Depending on the type of device employed, patients were divided into a powered circular stapler group (PCSG) and a manual circular stapler group (MCSG). Clinicopathological features and surgical outcomes were compared between the two groups.

Results: There were no differences in clinicopathological characteristics and surgical outcomes, except for anastomotic outcomes, between the two groups. Patients with positive air leak tests were significantly more in the MCSG (=0.026; PCSG, 1.5%; MCSG, 8.0%). Frequencies of anastomotic leakage (=0.486; PCSG, 6.1%; MCSG, 8.9%) and anastomotic bleeding (=1.000; PCSG, 0.7%; MCSG, 0.8%) were similar between the two groups. Multivariate analysis showed that the use of a powered circular stapler significantly increased the negative leak tests (=0.020, odds ratio 6.74, 95% confidence interval 1.35-33.56).

Conclusions: Use of a powered circular stapler in Ro-LAR for rectal cancer was significantly associated with a negative air leak test, suggesting that it contributes to stable and safe anastomosis.