Two-step pull-through colo-anal anastomosis aiming to avoid stoma in rectal cancer surgery: A “real life” study in a developing country - 04/06/21

Doi : 10.1016/j.jviscsurg.2021.04.004

M.A. Majbar ^a,^b, L. Courtot ^c, L. Dahbi-Skali ^a,^b, A. Rafik ^a,^b, P.O. Jouppe ^c, D. Moussata ^c, A. Benkabbou ^a,^b, R. Mohsine ^a,^b, M. Ouaissi ^c, A. Souadka ^a,^b,⁎
^a Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco
^b Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
^c Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic, and Liver Transplant Surgery, Trousseau Hospital, Tours, France

^⁎Corresponding author at: Digestive Surgical Oncology Department, National Institute of Oncology, Rabat, Morocco.Digestive Surgical Oncology Department, National Institute of OncologyRabatMorocco

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Friday 04 June 2021
This article has been published in an issue click here to access

Summary

Background

Delayed colo-anal anastomosis (DCA) is an underused technique rarely performed after resection of primary low rectal adenocarcinoma. The objective of this study was to compare the short-term outcomes of DCA and classical colo-anal anastomosis (CAA).

Methods

This is a retrospective comparative study carried out at two tertiary centres in Morocco and France. It included all patients who underwent colo-anal anastomosis after complete mesorectal excision for primary rectal adenocarcinoma between January 2018 and December 2019. The main outcomes were 90-day morbidity and rates completing the surgical steps of DCA and CAA.

Results

Among 215 rectal resections, 45 patients received colo-anal anastomosis, including 19 DCA and 26 CAA. Seventeen patients in the DCA group completed the two steps compared to 16 in the CAA group (89.5% vs. 61.5%, P=0.04). The rates of severe complications (26.9% vs. 26.3%, P=0.96) and anastomotic leakage (42.3% vs. 31.6%, P=0.46) were not different between the two groups.

Conclusion

This study showed that DCA was associated with a higher rate of completing the two surgical steps, with no difference in overall and severe morbidity. DCA may be a strong alternative to classical colo-anal anastomosis.

El texto completo de este artículo está disponible en PDF.

Keywords : Rectal neoplasms, Delayed colo-anal anastomosis, Anastomotic leakage, Ileostomy