Routine pathologic evaluation of circular stapler anastomotic rings is not useful after resection for colorectal cancer: retrospective study and systematic review with meta-analysis

Abstract

Background Circular staplers are commonly used for reconstruction after radical resection for colorectal cancer. Pathological analysis of the anastomotic rings is common practice, although the benefits are unclear. The purpose of this study was to evaluate the usefulness of routine histopathological analysis of anastomotic rings in an original series and in a systematic review of the literature. Method The retrospective study was performed at two university-associated academic hospitals in Winnipeg, Canada, including patients investigated for colorectal cancers (within 30 cm of the anal verge) who underwent resection between 2007 and 2020. The systematic review involved Ovid MEDLINE, Embase, Scopus, and Web of Science databases, selecting for adult human studies involving analysis of anastomotic rings in elective colorectal cancer resections. The main outcome measure was the proportion of patients with cancer in the anastomotic ring specimens. The frequency of benign pathology findings and changes to patient management were also examined. Results Out of 673 eligible patients, 487 were included in the retrospective analysis. No patients had cancer within the anastomotic ring specimens. Twenty-five patients (5.1 per cent) had benign pathological findings within the anastomotic ring specimens, and patient management was never affected. In the systematic review, 27 articles were included in the final analysis out of 5848 records reviewed. The rate of cancer within anastomotic ring specimens was 0.34 per cent, and the rate of change in patient management was 0.19 per cent. Conclusion The likelihood of finding cancer within anastomotic rings is rare and their histopathological examination seldom changes patient management.

Trends of colorectal cancer surgery in 2022

“…In particular, a large Canadian study 3 , analysing circular stapler anastomotic rings specimens from nearly 490 CRC resections, confirmed that their routine pathologic evaluation is not useful, as no patients had cancer in the ring specimen, 5.1 per cent had benign pathological findings and patients’ management was never affected by this result. Also, in another registry study including nearly 6200 patients from Sweden 4 , authors documented that the routine use of rectal washout during anterior resection did not impact the 3-year oncological outcomes, even if a reduction in local recurrence risk after the 5-year follow-up was observed.…”