P404 - CLOSE Trial: Tissue Adhesive versus Skin Stapling Comparing CLOSure Effectiveness in Colorectal Cancer Surgery -A multicenter Randomized controlled study

Sunday, May 10, 2026

1:07 PM - 1:15 PM ET

Abstract Podium Presenter(s)

In Kyeong Kim

Clinical assistant professor
Seoul St.Mary's hospital, The Catholic University of Korea
Seoul St.Mary's Hospital, The Catholic University of Korea
Seoul, Seoul-t'ukpyolsi, Republic of Korea

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.

Senior Author(s)

Yoon Suk Lee, n/a

Professor
Seoul St. Mary’s Hospital, College of Medicine, the Catholic University of Korea
Seocho gu, Seoul-t'ukpyolsi, Republic of Korea

Disclosure information not submitted.

Author(s)

JB

Jung Hoon Bae (he/him/his)

Assistant Professor
Seoul St.Mary's hospital, The Catholic University of Korea
Catholic University of Korea
Seoul, Seoul-t'ukpyolsi, Republic of Korea

Disclosure information not submitted.
IL

In Kyu Lee, n/a

Professor
Seoul St.Mary's hospital, The Catholic University of Korea
Seoul, Seoul-t'ukpyolsi, Republic of Korea

Disclosure information not submitted.
Ju Myung Song, 109802

Colorectal surgeon, Clinical Assistant Professor, Department of Surgery
Incheon Saint Mary Hospital
Incheon, Inch'on-jikhalsi, Republic of Korea

Disclosure information not submitted.
JK

Ji Hoon Kim, 81504

Colorectal Surgeon, Associate Professor, Department of Surgery
Incheon Saint Mary Hospital
Incheon, Inch'on-jikhalsi, Republic of Korea

Disclosure information not submitted.
JM

Ji Yeon Mun, n/a

Clinical assistant professor
St. Vincent's Hospital
Suwon-si, Kyonggi-do, Republic of Korea

Disclosure information not submitted.
Bong Hyeon Kye

Professor
St. Vincent's Hospital
The Catholic University of Korea
Suwon-si, Kyonggi-do, Republic of Korea

Disclosure information not submitted.

Purpose/Background: Superficial surgical site infection (SSI) remains a significant complication following colorectal cancer surgery, contributing to increased morbidity, healthcare costs, and patient dissatisfaction. Skin staplers may create micro-trauma and incomplete approximation. Tissue adhesive offer antimicrobial properties and waterproof protection, but comparative data remain limited. To compare the efficacy of tissue adhesive (2-octyl cyanoacrylate) versus skin staplers for wound closure in preventing SSI following minimally invasive colorectal cancer surgery, and evaluate wound complications, patient-reported satisfaction, and cost-effectiveness.

Methods/Interventions: This multicenter randomized controlled trial enrolled 310 patients undergoing minimally invasive colorectal cancer. Patients were randomly assigned 1:1 to wound closure using either 2-octyl cyanoacrylate tissue adhesive (Bond group, n=155) or skin stapler (Stapler group, n=155). Primary outcome was superficial SSI within 30 days after surgery. Secondary outcomes included wound complications, postoperative pain (VAS scores), patient scar assessment scale (POSAS), dressing requirements, and cost-effectiveness analysis

Results/Outcomes: Baseline characteristics were comparable between groups. Overall superficial SSI rate was 3.2% (10/310). Bond group had significantly lower SSI rate compared to the Stapler group (0.6% [1/155] vs 5.8% [9/155], p=0.009). Multivariate analysis confirmed tissue adhesive as an independent protective factor against SSI (adjusted OR 0.09, 95% CI 0.01-0.76, p=0.027), with wound length being a significant risk factor (OR 1.48 per cm, p=0.022).

VAS pain scores showed no significant difference across postoperative 1-3 day. Bond group required significantly fewer dressing changes (0.3±0.8 vs 2.8±1.6 times, p< 0.001), resulting in substantial cost savings: 100% reduction in dressing fees and 73.2% reduction in supply costs, substantial per-patient savings without considering prevented SSI treatment costs. Patient satisfaction scores favored the Bond group (2.89±1.57 vs. 3.57±1.71), with superior outcomes in scar pain, itching, surface irregularity, and overall satisfaction (POSAS total score: 19.26±9.53 vs. 20.45±9.20).

Conclusion/Discussion: Tissue adhesive is superior to stapler for wound closure in minimally invasive colorectal cancer surgery, significantly reducing superficial SSI risk by 90%, with substantially decreasing dressing requirements and associated costs. Patient satisfaction and scar assessment outcomes were also favorable with tissue adhesive. Combined with waterproof protection, elimination of painful staple removal, and superior cosmesis, these findings support the routine use of tissue adhesive for wound closure in colorectal surgery, potentially improving patient outcomes and optimizing healthcare resource utilization.

Cost-Effectiveness of Bond versus Stapler for Wound Closure.

Comparison of wound closure cost-related outcomes between bond and stapler groups. Bar graphs represent mean values for four cost categories: (A) dressing frequency(times), (B) dressing fee (KRW), (C) supply cost (KRW), and (D) total dressing cost (KRW).

Blue bars indicate the stapler group (N=155), and red bars indicate the bond group (N=155). Green dashed arrows with percentage values indicate the reduction rate achieved by the bond group compared to the stapler group. Error bars represent standard deviation (SD). *** p<0.001 indicates statistically significant difference between groups. KRW, Korean Won; SD, standard deviation.

Patient Scar Assessment Scale

Radar chart showing Patient Scar Assessment Scale (PSAS) scores for stapler (blue, n=49) versus bond (red, n=38) wound closure. Seven axes represent PSAS items (scale 1-10; lower scores better). Outer positions indicate better outcomes. Bond showed superior results in pain, itching, irregularity, and overall satisfaction.