Efficacy and safety of a NiTi CAR 27 compression ring for end-to-end anastomosis compared with conventional staplers: A real-world analysis in Chinese colorectal cancer patients

Abstract

OBJECTIVES:This study aimed to evaluate the safety and efficacy of a new nickel-titanium shape memory alloy compression anastomosis ring, NiTi CAR 27, in constructing an anastomosis for colorectal cancer resection compared with conventional staples.METHODS:In total, 234 consecutive patients diagnosed with colorectal cancer receiving sigmoidectomy and anterior resection for end-to-end anastomosis from May 2010 to June 2012 were retrospectively analyzed. The postoperative clinical parameters, postoperative complications and 3-year overall survival in 77 patients using a NiTi CAR 27 compression ring (CAR group) and 157 patients with conventional circular staplers (STA group) were compared.RESULTS:There were no statistically significant differences between the patients in the two groups in terms of general demographics and tumor features. A clinically apparent anastomotic leak occurred in 2 patients (2.6%) in the CAR group and in 5 patients (3.2%) in the STA group (p=0.804). These eight patients received a temporary diverting ileostomy. One patient (1.3%) in the CAR group was diagnosed with anastomotic stricture through an electronic colonoscopy after 3 months postoperatively. The incidence of postoperative intestinal obstruction was comparable between the two groups (p=0.192). With a median follow-up duration of 39.6 months, the 3-year overall survival rate was 83.1% in the CAR group and 89.0% in the STA group (p=0.152).CONCLUSIONS:NiTi CAR 27 is safe and effective for colorectal end-to-end anastomosis. Its use is equivalent to that of the conventional circular staplers. This study suggests that NiTi CAR 27 may be a beneficial alternative in colorectal anastomosis in Chinese colorectal cancer patients.

Safety evaluation of preoperative stent insertion and clinical analysis on comparison of outcomes between preoperative stent insertion and emergency surgery in the treatment of obstructive left-sided colorectal cancer

“…The success rate of nickel-titanium memory alloy stent insertion in colonic lumen by colonoscope is fairly hight, 8 but there are complications such as perforation, haemorrhage, slight abdominal pain, stent displacement, stent blockage and reobstruction and serious complication perforation is rarely seen. 9 The success rate of stent insertion is 97.62% in this study, close to that reported in a previous literature. 10 Two cases of perforation occurred in the early stage of stent insertion, which no longer occurred later.…”

The Colorectal Anastomosis: A Timeless Challenge

“…128 129 The ColonRing has performed well in clinical studies, demonstrating equivalence to traditional DST regarding anastomotic leak (2.6%), stricture, operative time, obstruction, and 3-year overall survival. 130 One subgroup analysis of patients undergoing LAR within 6 cm of the anal verge showed a leak rate of 5.3 versus 12.1% for stapled anastomosis (not statistically significant) with no grade C leaks among 38 patients. 131 A large multinational, multicenter registry review of 1,180 patients demonstrated 38 leaks (3.22%) with only four technical failures (0.34%).…”

Experimental Procedure of Compression Anastomosis Using Fragmented Rings: A Porcine Model

“…21 Cases of postoperative bowel obstruction have been reported in the literature with both nonfragmentable and biofragmentable rings. 4,16,33 Biofragmentation is based on the principle of oxidative biodegradation of a material. This phenomenon depends on conditions such as the rate of oxygen flow and the presence of microorganisms.…”