Efficacy of Anastomosis Enhancing Suture in Laparoscopic Anterior Resection of Middle-Low Rectal Cancer: A Prospective Cohort Study

Background：Anastomotic leakage (AL) limits the outcome after laparoscopic anterior resection (LAR) for middle-low rectal cancer. The study investigated the efficacy of laparoscopic anastomosis enhancing suture (LAES), preventive ileostomy and transanal drainage tube placement in reducing anastomotic leakage after LAR for middle-low rectal cancer.Methods：From April 2016 to April 2019, a prospective cohort study was performed on consecutive patients who underwent LAR for middle-low rectal cancer in Changzheng hospital. The patients were divided into group A, B, C and D in which LAES, transanal drainage tube placement, protective ileostomy, and no preventive treatment were applied, respectively. Clinical characteristics, operative variables and postoperative complication were compared between the groups.Results：Among 320 patients, 24 (7.5%) developed AL and incidence rate of AL was 1.3%, 12.5%, 1.3% and 15.0% in the four groups, respectively. Left colic artery preservation and neoadjuvant chemotherapy were found not associated with the incidence of AL. A total of 0, 2, 2 and 5 patients had anastomotic bleeding in the four groups, respectively. No patient underwent reoperation in group A and group C, while 5.0% (4/80) of the patients had reoperation in group B and group D due to grade C AL with severe symptoms.Conclusions：Compared with preventive ileostomy, LAES was effective in preventing AL after LAR for middle-low rectal cancer and relieving the complications of AL. The transanal drainage tube placement did not reduce the risk of AL.The study was retrospectively registered with the Chinese Clinical Trial Registry on 28th June 2016 (code: ChiCTR-IOR-17011777).