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Techniques in Coloproctology

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01-07-2018 | Original Article

Laparoscopic delayed coloanal anastomosis without diverting ileostomy for low rectal cancer surgery: 85 consecutive patients from a single institution

Authors: P.-Y. Sage, B. Trilling, P.-A. Waroquet, D. Voirin, E. Girard, J.-L. Faucheron

Published in: Techniques in Coloproctology | Issue 7/2018

Abstract

Background

Surgical treatment for low rectal cancer septic complications often requires an ileostomy for fecal diversion. Delayed coloanal anastomosis (CAA) has been performed for several years to reduce septic complications and to avoid ileostomy. The aim of this study was to report the technical, functional and oncological results of delayed CAA in patients operated on for low rectal cancer focusing on pelvic septic complications.

Methods

All consecutive patients operated on for low rectal cancer suitable for total mesorectal excision and two-step delayed CAA at a single institution between May 2000 and September 2013 were included in the study. Patients’ characteristics, operative and postoperative outcomes, long-term technical, functional and oncological results from a prospectively maintained database, were retrospectively analyzed.

Results

A total of 85 consecutive patients (69 men), of median age 63 years (range 42–83 years) were included. Median delay between the first and the second step of the operation was 6 days (range 2–13 days). Twenty-one patients (25%) developed pelvic sepsis, nine of them (10.6%) developed an anastomotic leak. Twenty-three patients had a definitive stoma at the end of follow-up. Seventeen patients (29%) experienced a poor functional result. Thirty-three patients (38%) presented with recurrence at a median follow-up of 59 months (range 12–135 months). Seven (8.2%) developed a local recurrence, 18 a distant metastasis (21.1%) and 8 (9.4%) both a local and distant recurrence.

Conclusions

In our series, laparoscopic total mesorectal excision with delayed coloanal anastomosis was associated with septic complications and oncologic results similar to those reported after total mesorectal excision with conventional anastomosis and ileostomy, nearly one-third of patients experience a poor functional result. A randomized trial comparing these two options for low rectal cancer is under way.

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Title: Laparoscopic delayed coloanal anastomosis without diverting ileostomy for low rectal cancer surgery: 85 consecutive patients from a single institution
Authors: P.-Y. Sage
B. Trilling
P.-A. Waroquet
D. Voirin
E. Girard
J.-L. Faucheron
Publication date: 01-07-2018
Publisher: Springer International Publishing
Published in: Techniques in Coloproctology / Issue 7/2018
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI: https://doi.org/10.1007/s10151-018-1813-2

At a glance: The STEP trials

Springer Medicine

Laparoscopic delayed coloanal anastomosis without diverting ileostomy for low rectal cancer surgery: 85 consecutive patients from a single institution

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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