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

Abstract

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.

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

“…In one 2019 review by Portale et al involving eight studies where patients underwent the T-C technique for rectal cancer, the reported rates of anastomotic leak and pelvic abscess ranged between 0-10.6% and 0-25%, respectively. 20 In the current study, the observed rates of anastomotic leakage (4.5%) and pelvic abscess (4.5%) were in line with previous reports. In studies analysing patients undergoing CAA with protective ileostomy due to rectal cancer, the reported figures for anastomotic leakage and pelvic abscess ranged between 3-20% and 3-10.5%, respectively.…”

“…In one 2019 review by Portale et al . involving eight studies where patients underwent the T–C technique for rectal cancer, the reported rates of anastomotic leak and pelvic abscess ranged between 0–10.6% and 0–25%, respectively 20 . In the current study, the observed rates of anastomotic leakage (4.5%) and pelvic abscess (4.5%) were in line with previous reports.…”

Delayed coloanal anastomosis: an alternative option for restorative rectal cancer surgery after high‐dose pelvic radiotherapy for prostate cancer

“…The literature shows good results with DCAA compared with immediate coloanal anastomosis with or without a J-pouch: Olagne et al [23] showed 70% good functional results at 2 years on 35 patients receiving 45 Gy and DCAA for low rectal cancer in accordance with Sage et al [24] and Jarry et al [21]. In a recent systematic review on DCAA for rectal cancer, Portale et al [25] reported poor faecal continence in less than 30% of patients. Preoperatively, patients are informed about these functional outcomes and postoperative rehabilitation programme and these elements are part of the decision process between restorative surgery and definitive stoma, especially for elderly patients.…”

Two-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Low Rectal Cancer

“…[19][20][21][22][23] In the last 2 decades, this technique has been reintroduced for the treatment of rectal cancer when trying to avoid diverting stoma and its related morbidity, with promising results. 20,[24][25][26] Two systematic reviews 27,28 studying results of transanal colonic pullthrough with 2-stage coloanal anastomosis for low rectal cancer showed a low rate of anastomotic leak, low pelvic morbidity, and low use of stoma, with reasonably good functional results. However, evidence of the advantages of the Turnbull-Cutait pull-through with 2-stage hand-sewn coloanal anastomosis (TCA) over standard hand-sewn coloanal anastomosis associated with diverting lateral ileostomy (CAA) in rectal cancer is scarce.…”