Anastomose colo-anale différée sans stomie de dérivation après résection antérieure basse du rectum

Facy, Olivier; Lagoutte, Nicolas; Jambet, S.; Radais, François; Favre, Jean‐Pierre; Rat, Patrick; Ortega‐Deballon, Pablo

doi:10.1016/j.jchir.2009.09.001

Cited by 12 publications

(13 citation statements)

References 16 publications

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“…Details on postoperative outcomes are shown in Table 3. Six out of eight studies reported no anastomotic leak [10–12, 14–16]. Pelvic sepsis/abscess ranged from 0 to 25%.…”

Section: Resultsmentioning

confidence: 99%

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Delayed Colo‐anal Anastomosis for Rectal Cancer: Pelvic Morbidity, Functional Results and Oncological Outcomes: A Systematic Review

Portale¹,

Popesc

Parotto

et al. 2019

World j. surg.

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Background Delayed colo-anal anastomosis (DCAA) has received renewed interest thanks to its reduction in anastomotic leakage rate without the use of stoma to protect a low rectal anastomosis. The aim of this review was to summarize the available literature on DCAA following rectal cancer resection and to report clinical, oncological and functional results. Methods A comprehensive literature review was conducted including MEDLINE/Pubmed, EMBASE, SCOPUS, clinicaltrials.gov and the Cochrane database of systematic reviews through July 2018. The review was conducted according to MOOSE guidelines. Quality was appraised with the methodological index for non-randomized studies (MINORS) tool. Results Eight observational studies (409 patients) were included. Average MINORS score was 9.6/14 in seven noncomparative studies and 17/22 in one comparative study. Six studies reported no anastomotic leak. Pelvic sepsis/ abscess ranged from 0 to 25%. Mortality rate was\3% in seven studies and 12.5% in one. Poor fecal continence was reported in \30% of patients. Need for permanent stoma was B2% in six studies. A five-year survival rate ranged from 63.8 to 81% (four studies). Loco-regional recurrence rate ranged from 4.8 to 14.3% at 3 years (four studies) and from 6 to 38.8% at 5 years (three studies). Conclusion DCAA offers an alternative to primary straight colo-anal anastomosis for low rectal cancer. The benefits include reduced risk of anastomotic leakage and pelvic sepsis, and no need for protective ileostomy, with good functional and oncological outcomes. Results of ongoing randomized controlled trials comparing DCAA with straight colo-anal anastomosis and protective stoma are awaited to draw definitive conclusions.

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“…Details on postoperative outcomes are shown in Table 3. Six out of eight studies reported no anastomotic leak [10–12, 14–16]. Pelvic sepsis/abscess ranged from 0 to 25%.…”

Section: Resultsmentioning

confidence: 99%

“…Mortality rate was less than 3%, except in one study (12.5%, one in eight patients) [14]. Need for reoperation was nil in four studies [10, 14–16], less than 3% in one study [11] and 10–17.6% in three studies [12, 13, 17].…”

Section: Resultsmentioning

confidence: 99%

Delayed Colo‐anal Anastomosis for Rectal Cancer: Pelvic Morbidity, Functional Results and Oncological Outcomes: A Systematic Review

Portale¹,

Popesc

Parotto

et al. 2019

World j. surg.

View full text Add to dashboard Cite

show abstract

“…Four of our patients initially presented with acute or chronic sepsis, which compares to rates reported in previous series. 5,8 Most patients remained ambulatory and were able to resume a low-residue diet between the 2 stages of the procedure. A systematic review of the literature on DCA revealed that the mean interval between the 2 stages of the procedure is 7 (range 5-10) days.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have reported good success with DCA without fecal diversion. [7][8][9] However, that was in elective settings, such as resection for primary treatment of rectal cancer. In a salvage situation, most patients require diversion of fecal stream to help with the control of local sepsis before treatment with DCA.…”

Section: Discussionmentioning

confidence: 99%

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Anastomotic salvage after rectal cancer resection using the Turnbull–Cutait delayed anastomosis

et al. 2014

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Background: Turnbull-Cutait abdominoperineal pull-through followed by delayed coloanal anastomosis (DCA) was first described in 1961. Studies have described its use for challenging colorectal conditions. We reviewed our experience with Turnbull-Cutait DCA as a salvage procedure for complex failure of colorectal anastomosis. Methods:We performed a retrospective cohort study from October 2010 to September 2011, with analysis of postoperative morbidity and mortality.Results: Seven DCAs were performed for anastomotic complications (3 chronic leaks, 2 rectovaginal fistulas, 1 colovesical fistula, 1 colonic ischemia) following surgery for rectal cancer. Six patients had a diverting ileostomy constructed as part of previous treatment for anastomotic complications before the salvage procedure. No anastomotic leaks were observed. All procedures but 1 were completed successfully. One patient who underwent DCA subsequently required an abdominoperineal resection and a permanent colostomy for postoperative extensive colonic ischemia. No 30-day mortality occurred. Conclusion:Salvage Turnbull-Cutait DCA appears to be a safe procedure and could be offered to patients with complex anastomotic complications. This procedure could be added to the surgeon's armamentarium as an alternative to the creation of a permanent stoma. Résultats : Sept CAD ont été réalisées en raison de complications anastomotiques (3 fuites anastomotiques chroniques, 2 fistules rectovaginales, 1 fistule colovésicale, 1 ischémie colique) résultant du traitement chirurgical d'un cancer rectal. Six patients avaient subi une iléostomie de dérivation pour fuite anastomotique, dans la période précédant la CAD de sauvetage. À l'exception d'un patient, toutes les procédures se sont soldées en succès. Aucune fuite anastomotique n'a été observée après CAD. Un patient a dû subir une résection abdominopérinéale avec colostomie terminale permanente en raison d'ischémie colique aigue du colon distal après CAD. Aucun décès n'est survenu dans les 30 jours suivant la CAD.Conclusion : La CAD de sauvetage apparait comme une intervention sécuritaire qui représente une option thérapeutique valable pour les patients souffrant de complications complexes de fuites anastomotiques colorectales. Cette intervention pourrait s'ajouter à l'arsenal du chirurgien comme alternative à la création d'une stomie permanente.

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The clinical results of the Turnbull–Cutait delayed coloanal anastomosis: a systematic review

et al. 2014

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Turnbull and Cutait described abdominoperineal pull-through followed by delayed coloanal anastomosis (DCA) in 1961. DCA could reduce anastomotic leaks, pelvic morbidity and use of stomas. Strong evidence about its clinical benefits is still lacking. This systematic review examined the clinical outcomes of DCA for the treatment of malignant or benign colorectal conditions. A systematic search of electronic medical databases was conducted. Two independent reviewers selected studies, extracted data and assessed risk of bias. The primary outcome was pelvic morbidity (anastomotic leak, pelvic abscess or sepsis, use of stoma). Fecal continence and survival data were also analyzed. From 1,251 citations, we included seven observational studies including 1,124 patients. All included studies were considered at high risk of bias. Two studies comparing DCA with immediate anastomosis reported a significant decrease in anastomotic leak, and pelvic abscess or sepsis. Low rates of pelvic morbidity were reported in the other five studies: anastomotic leak 0-7 %, pelvic abscess 0-11.8 % and pelvic sepsis 6.8-10 %. Rates of permanent stoma after DCA were low in six studies (1-6 %), with one study reporting an incidence of 25 %. Fecal continence was reported as satisfying in all studies. No differences were observed in a comparative setting. Survival data were reported in four studies. Clinical heterogeneity and methodological issues precluded meta-analysis. Based on retrospective evidence, DCA offers a low rate of anastomotic leak, pelvic morbidity and use of stoma, with reasonable fecal continence. Results are encouraging, but prospective studies are needed for comparison with standard of care.

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Anastomose colo-anale différée sans stomie de dérivation après résection antérieure basse du rectum

Cited by 12 publications

References 16 publications

Delayed Colo‐anal Anastomosis for Rectal Cancer: Pelvic Morbidity, Functional Results and Oncological Outcomes: A Systematic Review

Delayed Colo‐anal Anastomosis for Rectal Cancer: Pelvic Morbidity, Functional Results and Oncological Outcomes: A Systematic Review

Anastomotic salvage after rectal cancer resection using the Turnbull–Cutait delayed anastomosis

The clinical results of the Turnbull–Cutait delayed coloanal anastomosis: a systematic review

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