Presentation Information
[SY5-2]Evaluating the Efficacy of Powered Circular Staplers in Colorectal Cancer Surgery: A Meta-Analysis of 3,301 Patients
*Masatsune Shibutani1, Hiroshi Ohtani2, Shusei Endo1, Tomoya Tsukida1, Hideki Tanda1, Yuki Seki1, Hiroaki Kasashima1, Jyunya Nishimura3, Tatsunari Fukuoka3, Takafumi Nishii3, Kiyoshi Maeda1 (1. Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Japan, 2. Department of Surgery, Ohno Memorial Hospital, 3. Department of Surgery, Osaka City General Hospital)
[Objective] Anastomosis using the double-stapling technique (DST) is a cornerstone of left-sided colorectal cancer surgery. However, the incidence of anastomotic leakage (AL) has remained stagnant at approximately 10% for decades, representing a persistent "stalemate" in surgical outcomes. We previously reported the first evidence from Asia demonstrating that the Echelon Circular™ Powered Stapler (ECPS) significantly reduces AL compared to manual circular staplers (MCS). This study aims to establish robust, universal evidence for the clinical utility of ECPS by conducting an updated meta-analysis incorporating the latest global data.
[Materials and Methods] We conducted a comprehensive literature search across PubMed and Cochrane Library for clinical studies published between 2018 and August 2024 comparing ECPS and MCS in left-sided colorectal surgery. The primary endpoint was the overall AL rate. Secondary endpoints included major AL (reoperation or Grade B/C) and anastomotic bleeding. A subgroup analysis of Japanese cohorts was also performed to evaluate regional consistency.
[Results] Nine studies involving 3,301 patients (ECPS: 1,465; MCS: 1,836) were included. The ECPS group had a significantly lower overall AL rate than the MCS group (RR: 0.55; 95% CI: 0.42–0.72; p < 0.001). Notably, ECPS reduced the incidence of Major AL by nearly half (RR: 0.52; 95% CI: 0.35–0.78; p = 0.002). Subgroup analysis of Japanese patients confirmed consistent benefits. No significant difference was observed in anastomotic bleeding.
[Conclusion] This meta-analysis of 3,301 patients confirms the universal superiority of powered stapling. The transition to "powered" technology, combined with the 3D stapling technology that provides superior tissue grasping and preserves perfusion, has successfully broken the long-standing stalemate in AL rates. By dramatically reducing Major AL, ECPS is poised to become the new standard in colorectal surgery.
[Materials and Methods] We conducted a comprehensive literature search across PubMed and Cochrane Library for clinical studies published between 2018 and August 2024 comparing ECPS and MCS in left-sided colorectal surgery. The primary endpoint was the overall AL rate. Secondary endpoints included major AL (reoperation or Grade B/C) and anastomotic bleeding. A subgroup analysis of Japanese cohorts was also performed to evaluate regional consistency.
[Results] Nine studies involving 3,301 patients (ECPS: 1,465; MCS: 1,836) were included. The ECPS group had a significantly lower overall AL rate than the MCS group (RR: 0.55; 95% CI: 0.42–0.72; p < 0.001). Notably, ECPS reduced the incidence of Major AL by nearly half (RR: 0.52; 95% CI: 0.35–0.78; p = 0.002). Subgroup analysis of Japanese patients confirmed consistent benefits. No significant difference was observed in anastomotic bleeding.
[Conclusion] This meta-analysis of 3,301 patients confirms the universal superiority of powered stapling. The transition to "powered" technology, combined with the 3D stapling technology that provides superior tissue grasping and preserves perfusion, has successfully broken the long-standing stalemate in AL rates. By dramatically reducing Major AL, ECPS is poised to become the new standard in colorectal surgery.