# Patient‐Reported Outcomes and Surgical Results of Hand‐Sewn Versus Stapled Anastomosis for Lower Rectal Cancer Located 4–5 cm From the Anal Verge: A Subanalysis of the Ultimate Study

## TL;DR

This study compares hand-sewn and stapled anastomosis for lower rectal cancer, finding stapled methods better for anorectal function without compromising safety.

## Contribution

The study provides the first direct comparison of functional outcomes between hand-sewn and stapled anastomosis for lower rectal cancer.

## Key findings

- Stapled anastomosis showed consistently better Wexner scores for anorectal function at multiple follow-up points.
- Post-operative complications and oncological outcomes were similar between the two groups.
- Tumors in the hand-sewn group were located slightly closer to the anal verge.

## Abstract

Preserving anorectal function while achieving oncological success is crucial in the treatment of lower rectal cancer near the anal canal. Despite advancements in laparoscopic surgery that facilitate anal preservation, post‐operative anorectal dysfunction considerably affects quality of life. Both hand‐sewn and stapled anastomoses are suitable options for tumors located 4–5 cm from the anus. However, evidence comparing the functional outcomes and complications associated with both anastomosis methods is lacking.

This multicenter, single‐arm prospective study included patients with cT1‐T2/N0/M0 adenocarcinoma located 4–5 cm from the anal verge, scheduled for upfront laparoscopic surgery. Anorectal function, post‐operative complications, urinary and male sexual function, and oncological outcomes were assessed using the validated scores.

A total of 135 patients were analyzed and divided into hand‐sewn (n = 65) and stapled (n = 70) groups. The patient characteristics were similar, except for the tumors in the hand‐sewn group located 1 mm closer to the anal verge. No significant differences were observed in the post‐operative complications. Anorectal function, measured using Wexner scores, worsened at 3 months postoperatively and gradually improved in both groups. At 3, 6, 12, 24, and 36 months, the stapled group consistently showed better Wexner scores than the hand‐sewn group. Urinary function, sexual function, and oncological outcomes were similar in both groups.

Stapled anastomosis may provide better anorectal function with comparable safety and oncological outcomes to hand‐sewn anastomosis. Therefore, stapled anastomosis may be preferred for tumors located 4–5 cm from the anal verge to ensure oncological safety.

This study was registered in the UMIN Clinical Trials Registry System (UMIN 000011750)

Preserving anorectal function while ensuring oncological success is critical in lower rectal cancer surgery. This multicenter prospective study compared hand‐sewn and stapled anastomosis in 135 patients with tumors 4–5 cm from the anal verge. Although post‐operative complications and oncological outcomes were similar, stapled anastomosis consistently demonstrated better anorectal function.