Researchers Propose Safe Alternative to Standard Coloanal Anastomosis After Resection for Low Rectal Cancer

The 2-stage pull-through hand-sewn coloanal anastomosis is safe for use in patients with low rectal cancer who have undergone resection, with a similar complication rate to standard treatment, according to the results of a multi-center clinical trial (JAMA Surg. 2020 Jun 3. Epub ahead of print).

“Two-stage Turnbull-Cutait pull-through hand-sewn coloanal anastomosis seems to provide benefits in terms of postoperative morbidity compared with standard hand-sewn coloanal anastomosis associated with diverting ileostomy and further ileostomy reversal in patients operated on for low rectal cancer,” Sebastiano Biondo, MD, Bellvitge University Hospital, University of Barcelona, Spain, and co-investigators wrote on the purpose of this study.

A total of 92 patients were randomly assigned to undergo 2-stage Turbbull-Cutait pull-through (n = 46) or standard hand-sewn coloanal anastomosis with diverting ileostomy (n = 46).

The primary outcome was 30-day postoperative morbidity. For the standard hand-sewn coloanal anastomosis with diverting ileostomy arm, overall postoperative morbidity included 30-day postoperative complications of the ileostomy closure.

Data were analyzed from June 2012 to October 2018 for patients undergoing ultra-low anterior rectal resection needing hand-sewn coloanal anastomosis.

According to the researchers, 7 (15.2%) patients in the standard hand-sewn coloanal anastomosis arm did not undergo reversal ileostomy while 1 patient in the 2-stage pull-through hand-sewn coloanal anastomosis arm did not undergo delayed coloanal anastomosis.

They found that the 30-day overall postoperative complications rate was similar between both arms, with 34.8% of patients in the 2-stage pull-through arm experiencing complications compared with 45.7% of patients in the standard arm.

“The 2-stage pull-through hand-sewn coloanal anastomosis after ultralow anterior resection for low rectal cancer is safe and does not increase the postoperative morbidity rate compared with standard coloanal anastomosis with covering ileostomy followed by ileostomy closure,” Dr. Biondo et al concluded.—Kaitlyn Manasterski