Can rectal washout reduce anastomotic recurrence after anterior resection for rectal cancer? A review of the literature

Local recurrence rates of rectal cancer after anterior resection remain high, despite the continued efforts of surgeons to devise preventive measures. Anastomotic recurrence, a form of local recurrence, may be caused by the implantation of exfoliated cancer cells during resection, and rectal stump washout has been proposed as a way to reduce the risk of this occurring. In this review article, we explore the mechanism of anastomotic recurrence after low anterior resection for rectal cancer, and examine the history and effectiveness of rectal washout on reducing recurrence rates, with a focus on washout solutions, procedures, and devices. Despite the lack of evidence from randomized trials, rectal washout with normal saline or diluted iodine is performed almost routinely during low anterior resection. Clamping is usually done using cross-clamps, linear staplers, tourniquets, and other devices. Although viable cancer cells may be shed into the rectal lumen during surgical resection, their impact on anastomotic recurrence remains uncertain. However, washout poses little or no harm to patients, and appears acceptable as a routine procedure. Randomized controlled trials or large observational studies may help to clarify the best practices for rectal washout.