Local recurrence of rectal carcinoma after hand-sewn and stapled anastomoses

A retrospective analysis was conducted of 119 consecutive patients in whom potentially curative anterior resection of invasive rectal carcinoma was performed between 1976 and 1982. Seventy-six anastomoses were stapled and 43 were hand-sewn. The distributions of tumor stage, location, histologic grade, size, and margins of resection were similar for both groups. The probability of local recurrence by two years for middle rectal tumors was 26±7 percent for the group with stapled anastomoses and 10±7 percent for those with hand-sewn anastomoses (P=0.07, log-rank test). Local recurrence probabilities did not differ for upper rectal tumors (P=0.14) or lower rectal tumors (P=0.20). Anatomic considerations that encourage use of the stapler may explain our findings.