Efficacy of anastomotic reinforcement suture in laparoscopic anterior resection for middle-low rectal cancer: a propensity-score-matched cohort study.

Abstract

Background: Anastomotic leakage (AL) remains the most consequential complication limiting the outcome of laparoscopic anterior resection (LAR) for middle-low rectal cancer. We compared the efficacy of laparoscopic anastomotic reinforcement suture (LARS), transanal drainage tube (TDT) placement, diverting ileostomy and no prophylactic measure in reducing AL after LAR.

Methods: Consecutive patients undergoing laparoscopic LAR for rectal cancer at our institution between January 2020 and January 2025 were retrospectively reviewed. According to the prophylactic measure used, patients were assigned to Group A (LARS), Group B (TDT), Group C (diverting ileostomy) or Group D (no prophylaxis). Propensity scores for this four-arm allocation were estimated by multinomial logistic regression on 16 baseline covariates, and sequential 1:1:1:1 nearest-neighbour matching on the logit of the propensity score was performed (caliper 0.20 × SD of the logit, without replacement); covariate balance was assessed by standardised mean differences (SMD < 0.10). Baseline characteristics, intra-operative variables and postoperative complications were compared before and after matching.

Results: After matching, 320 patients (80 per group) were included. Overall, 32 patients (10.0%) developed AL, with incidences of 2.5%, 13.8%, 8.8% and 15.0% in Groups A, B, C and D, respectively (P < 0.05). Left colic artery preservation and neoadjuvant chemotherapy were not associated with AL (P > 0.05). Anastomotic bleeding occurred in 0, 2, 2 and 4 patients, respectively (P > 0.05). No reoperation was required in Group A or C, whereas 5 (6.3%) and 8 (10.0%) patients in Groups B and D, respectively, underwent reoperation for grade C AL with severe symptoms (P < 0.05). Stoma-related complications occurred in 16/80 patients (20.0%) in Group C and were absent in the other three groups.

Conclusions: In this propensity-score-matched retrospective cohort, LARS was associated with a lower incidence of clinically relevant AL than no prophylactic measure, and with a complication profile comparable to that of diverting ileostomy but without stoma-related morbidity. TDT placement did not confer a measurable reduction in AL. Given the retrospective design and the possibility of residual treatment-allocation bias, these findings warrant confirmation in prospective randomised trials.