Table1_Short- and long-term outcomes of laparoscopic low anterior resection with “dog ear” invagination anastomosis for mid and distal rectal cancer a propensity score matched analysis.docx

BackgroundThe lateral intersecting margin (dog-ear) was a weak spot of the double stapled technique (DST), We designed “dog-ear” invagination anastomosis (DAIA), which could eliminate the “dog-ear” in laparoscopic anterior resection.Patients and methodsA total of 202 patients underwent elective curative LLAR + DST (n = 143) or LLAR + DAIA (n = 59) were enrolled in the study. Propensity score matching (PSM) was used to minimize the adverse effects. The clinical data between LLAR + DST and LLAR + DAIA was compared, and the effect of factors on overall survival (OS) and disease-free survival (DFS) was analyzed.ResultsAfter PSM, 53 pairs of the LLRA + DST and LLRA + DAIA patients were enrolled in the study. The LLRA + DAIA group has a higher level (3.50 ± 1.03 vs. 2.87 ± 1.10, P = 0.01) of the anastomosis than that of the LLRA + DST group. Patients in LLAR + DAIA group have a lower incidence of protecting loop ileostomy compared to LLAR + DST group (20.75% vs. 5.66%, P  0.05).ConclusionLaparoscopic low anterior resection with “dog-ear” invagination anastomosis technique are well-established procedures for patients with low rectal cancer. “Dog-ear” invagination anastomosis technique may reduce the incidence of protecting loop ileostomy and significantly affect LARS score, and demonstrate a positive impact on the quality of life after surgery.

背景：侧向交错缘（狗耳）是双吻合器技术（DST）的薄弱环节。本研究设计了“狗耳”内陷吻合术（DAIA），旨在消除腹腔镜前切除术中的“狗耳”现象。受试者与方法：共有202名患者接受了选择性根治性低位前切除术（LLAR）+ DST（n=143）或LLAR+DAIA（n=59）的治疗，并纳入本研究。采用倾向评分匹配（PSM）以最小化不良影响。比较了LLAR+DST与LLAR+DAIA之间的临床数据，并分析了影响因素对总生存期（OS）和无病生存期（DFS）的影响。结果：经过PSM后，共有53对LLAR+DST和LLAR+DAIA患者被纳入研究。LLAR+DAIA组的吻合水平较LLAR+DST组显著提高（3.50±1.03 vs. 2.87±1.10，P=0.01）。与LLAR+DST组相比，LLAR+DAIA组保护性回肠造口的发生率更低（20.75% vs. 5.66%，P<0.05）。结论：采用“狗耳”内陷吻合术的腹腔镜低位前切除术是治疗低位直肠癌患者的一项成熟手术方法。‘狗耳’内陷吻合术可能降低保护性回肠造口的发生率，显著影响LARS评分，并显示出对术后生活质量的正向影响。