An Old Method Turnbull Cutait; Using for Middle and Distal Rectal Cancer Surgery without Ileostomy. Oncological and Fuctional Late Outcomes

Abstract

Aim: Anastomotic leak after sphincter-preserving surgery for rectal cancer may be a disaster scenario. To reduce the severity of anastomotic leakage a prophylactic diverting ileostomy is usually used for mid or distal rectal cancer patients. However, Turnbull Cutait Abdominoperineal Pull-Through Procedure (T-C) with low anastomotic leakage rates is an old method that is applied without diverting ileostomy. We aimed to evaluate the long-term functional and oncological results of the T-C procedure performed in patients with rectum cancer refusing diverting ileostomy. Method: Patients with middle or low rectal cancer who underwent T-C from March 2006 to December 2012 retrospectively reviewed for late results. Demographics, oncologic characteristics, postoperative complications, fuctional outcomes and overall survival (OS) time were evaluated. For functional results, Wexner Continence Grading scale scores, bladder functions, sexual functions, and SF-12 questionnaires were performed in all patients. In addition, anal manometry and defecography were performed in 7 patients. Results: Thirteen patients (6 men) median age 55 (range 44-82) years with rectal tumors at a median distance of 4 cm (range 1.5-7) from the anal verge underwent T-C. Mean follow-up was 101.2 (standard deviation 42.7) mounts. The 5-year OS rates was 85%. Postoperative morbidity rate is 23% (3 patients). However, pelvic sepsis, anastomotic leak and perianal fistula were not seen. Functional results were good in 90% of patients at the end of the second year. Due to ongoing fragmentation and evacuation problems, 2 patients underwent permanent stoma. Conclusion: T-C with reasonable oncologic and functional results can be safely used sphincter-preserving procedure to treat patients with middle and distal rectal cancer without creation of diverting ileostomy.

Long-Term Results of 2-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Low Rectal Cancer

“…The same authors published a retrospective study about long-term oncological and functional outcomes of 13 patients with rectal cancer reconstructed using the TCA technique after neoadjuvant chemoradiotherapy and reported a 5-year survival rate of 85%, very similar to that reported in our study, with a 90% OS and 80.1% DFS at 5 years. 25 Regarding the functionality outcomes, 3 patients required permanent stoma (23%), which is in line with our results.…”

Turnbull–Cutait technique without ileostomy after total mesorectal excision is associated with acceptably low early post‐operative morbidity

“…26 Regarding functional outcomes, three patients required permanent stoma (two patients due to severe rectal evacuation problem and one patient due to anastomotic stenosis), and 90% of patients had satisfactory gas and faecal continence at the end of 2 years. 26 The T-C technique has also been used as a salvage procedure in several studies with encouraging results; thus, it may have a place in the management of such difficult clinical cases as well. 7,8,27 Theoretical explanations for low rates of anastomotic leakage and pelvic septic complications in patients undergoing the T-C technique include the initially insignificant effect of the retraction on the pulled-through colonic segment due to contracted pelvic diaphragm at the termination of surgery as there is no anastomosis as well as by the prevention of the retraction of the colonic segments due to adhesions forming between the exteriorized colonic segment and anus during the waiting period.…”

“…A study examining the long‐term oncological and functional outcomes of 13 middle and distal rectal cancer patients operated with the T–C technique following neoadjuvant chemoradiotherapy reported the 5‐year survival rate of 85% and no local recurrence during a mean follow‐up of 101.2 months 26 . Regarding functional outcomes, three patients required permanent stoma (two patients due to severe rectal evacuation problem and one patient due to anastomotic stenosis), and 90% of patients had satisfactory gas and faecal continence at the end of 2 years 26 …”