This letter comments on a recent study comparing two-row and three-row circular staplers in colorectal cancer surgery. We highlight methodological limitations related to the use of historical controls, evolving perioperative practices, and limited event numbers, which may confound the observed reduction in anastomotic leakage. Current evidence does not conclusively support the superiority of triple-row staplers, underscoring the need for prospective studies using standardized modern protocols.
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WillisMAToewsISoltauSL, et al.Preoperative combined mechanical and oral antibiotic bowel preparation for preventing complications in elective colorectal surgery. Cochrane Database Syst Rev. 2023;2:CD014909.
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BalaphasASleimanMJMeuretteG, et al.Impact of fluorescence angiography on anastomotic leak and complication rate in colorectal surgery: a systematic review and meta-analysis of randomized controlled trials. Colorectal Dis. 2025;27:e70236.
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FiorilloCTondoloVBiffoniB, et al.Circular staplers and anastomotic leakage in colorectal surgery: meta-analysis. BJS Open. 2025;9:zrae170.