To assess the specific results of delayed coloanal anastomosis (DCAA) in light of its two main indications.DCAA can be proposed either immediately after a low anterior resection (primary-DCAA) or after failure of a primary pelvic surgery as a salvage procedure (salvage-DCAA).All patients who underwent DCAA intervention at 30 GRECCAR-affiliated hospitals between 2010 and 2021 were retrospectively included.564 patients (male: 63%; median age: 62 years IQR[53-69]) underwent a DCAA: 66% for primary-DCAA and 34% for salvage-DCAA. Overall morbidity, major morbidity and mortality were 57%, 30% and 1.1%, without any significant differences between primary-DCAA and salvage-DCAA (P=0.933;P=0.238 andP=0.410 respectively). Anastomotic leakage was more frequent after salvage-DCAA (23%) than after primary-DCAA (15%), (P=0.016).Fifty-five patients (10%) developed necrosis of intra-abdominal colon. In multivariate analysis, intra-abdominal colon necrosis was significantly associated with male sex (OR=2.67 95%CI[1.22-6.49];P=0.020), BMI>25 (OR=2.78 95%CI[1.37-6.00];P=0.006) and peripheral artery disease (OR=4.68 95%CI[1.12-19.1];P=0.030). The occurrence of this complication was similar between primary-DCAA (11%) and salvage-DCAA (8%), (P=0.289).Preservation of bowel continuity was reached 3 years after DCAA in 74% of the cohort (primary-DCAA:77% vs. salvage-DCAA: 68%,P=0.031). Among patients with a DCAA fashioned without diverting stoma, 75% (301/403) have never required a stoma at the last follow-up.DCAA makes it possible to definitively avoid a stoma in 75% of patients when fashioned initially without stoma and to save bowel continuity in 68% of the patients in the setting of failure of primary pelvic surgery.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Low anterior resection of the rectum for cancer (LAR) entails a risk of symptomatic anastomotic leakage as well as impaired anorectal function, both of which may eventually result in the need for a permanent stoma (PS). The aim was to investigate the incidence of and risk factors for PS beyond 5 years following LAR.

Theoretical advantages of Turnbull-Cutait pull-through delayed coloanal anastomosis (DCAA) are a reduced risk of anastomotic leak and therefore avoidance of stoma. Gradually abandoned in favor of immediate coloanal anastomosis (ICAA) with diverting stoma, DCAA has regained popularity in recent years in reconstructive surgery for low RC, especially when combined with minimally invasive surgery (MIS). The aim of this study was to perform the first meta-analysis, exploring the safety and outcomes of DCAA compared to ICAA with protective stoma.A systematic search of MEDLINE, EMBASE, and CENTRAL and Google Scholar databases was performed for studies published from January 2000 until December 2020. The systematic review and meta-analysis were performed according to the Cochrane Handbook for Systematic Review on Interventions recommendations and Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines.Out of 2626 studies screened, 9 were included in the systematic review and 4 studies in the meta-analysis. Outcomes included were postoperative complications, pelvic sepsis and risk of definitive stoma. Considering postoperative complications classified as Clavien-Dindo III, no significant difference existed in the rate of postoperative morbidity between DCAA and ICAA (13% versus 21%; OR 1.17; 95% CI 0.38-3.62; p = 0.78; I = 20%). Patients in the DCAA group experienced a lower rate of postoperative pelvic sepsis compared with patients undergoing ICAA with diverting stoma (7% versus 14%; OR 0.37; 95% CI 0.16-0.85; p = 0.02; I = 0%). The risk of definitive stoma was comparable between the two groups (2% versus 2% OR 0.77; 95% CI 0.15-3.85; p = 0.75; I = 0%).According to the limited current evidence, DCAA is associated with a significant decrease in pelvic sepsis. Further prospective trials focusing on oncologic and functional outcomes are needed.© 2022. Springer Nature Switzerland AG.

In patients operated on for low rectal cancer, 2-stage Turnbull-Cutait pull-through hand-sewn coloanal anastomosis provides benefits in terms of postoperative morbidity compared with standard hand-sewn coloanal anastomosis associated with diverting ileostomy and further ileostomy reversal.To compare long-term results of these 2 techniques after ultralow rectal resection for rectal cancer.In this randomized multicenter clinical trial, neither patients nor surgeons were blinded for technique. Patients were recruited in 3 centers. Patients undergoing ultralow anterior rectal resection needing hand-sewn coloanal anastomosis were randomly assigned to 2-stage Turnbull-Cutait pull-through hand-sewn coloanal anastomosis (n = 46) or standard hand-sewn coloanal anastomosis associated with diverting ileostomy (n = 46).All patients underwent ultralow anterior resection. Patients assigned to the 2-stage Turnbull-Cutait pull-through group underwent exteriorization of a segment of left colon through the anal canal. After 6 to 10 days, the exteriorized colon was resected and a delayed hand-sewn coloanal anastomosis performed. For patients assigned to standard coloanal anastomosis, the hand-sewn coloanal anastomosis was performed with diverting ileostomy during the first operation. Ileostomy closure was scheduled after adjuvant treatment was completed in about 6 to 8 months.The study aimed to compare the differences between the 2 groups in terms of long-term surgery-related morbidity, functional, and oncological outcomes at 3 years postoperatively. Data were analyzed from October 1, 2018, through October 31, 2021.The 92 patients randomized in the first study were included for the 3-year follow-up. The overall morbidity rate in the 2 groups showed that 15 patients (16.3%) had complications with a difference of 6.52 (95% CI, -8.93 to 21.79). Nine patients (19.6%) and 6 patients (13.0%) in the 2-stage Turnbull-Cutait pull-through group and hand-sewn coloanal anastomosis group, respectively, had complications without statistically significant differences (P = .57). Oncological results were comparable between the groups. Long-term fecal continence in the CCA and TCA groups, respectively, assessed using the Wexner Incontinence Score was 10.9 (5.50-15.5) vs 13.0 (7.25-16.0; P = .92), Low Anterior Resection Syndrome score was 32.0 (21.0-37.0) vs 34.0 (23.2-38.5; P = .76), and Colorectal Functional Outcome score was 38.5 (23.0-47.1) vs 40.8 (23.3-58.2; P = .30).In this study, after a 3-year follow-up period, 2-stage Turnbull-Cutait anastomosis for ultralow rectal cancer could be considered as a surgical alternative that has the valuable benefit of avoiding a temporary stoma with similar results in terms of morbidity, fecal continence, patient satisfaction, quality of life, and oncological outcomes when compared with hand-sewn coloanal anastomosis with ileostomy.ClinicalTrials.gov Identifier: NCT01766661.

This post-hoc analysis of the LASRE trial aims to evaluate the impact of body mass index (BMI) on surgical difficulty and oncological outcomes in patients undergoing laparoscopic or open resection for low rectal cancer.The LASRE trial was a multicenter, randomized controlled trial comparing laparoscopic and open surgery for low rectal cancer. Patients aged 18-75 years with rectal adenocarcinoma located within 5 cm of the dentate line were enrolled and stratified into four BMI groups: underweight (BMI < 18.5 kg/m), normal weight (BMI 18.5-23.9 kg/m), overweight (BMI 23.9-27.9 kg/m), and obese (BMI ≥ 28.0 kg/m). The primary endpoints were surgical difficulty, circumferential resection margin (CRM) positivity, and postoperative complications.A total of 1,039 patients were included. Obese patients exhibited significantly longer operative times (P < 0.001) and higher intraoperative blood loss (P = 0.001). The 30-day complication rate (P = 0.030) and Clavien-Dindo classification (P = 0.040) differed significantly between groups. However, CRM positivity rates did not significantly differ between BMI groups (P = 0.42). During the median follow-up of 36 months, the 3-year OS rate was comparable across BMI groups (P = 0.709), and the 3-year DFS rate showed no significant differences among the BMI groups (P = 0.966).Higher BMI increases surgical difficulty and postoperative complications in low rectal cancer but does not significantly impact CRM positivity or DFS. These findings underscore the importance of considering BMI in surgical planning and patient counseling.© 2025. The Author(s).

Obesity is a growing global health concern and poses significant challenges in rectal cancer surgery. Excess visceral fat can obscure surgical landmarks, complicate dissection, and increase the risk of intraoperative adverse events (iAEs). Despite these recognized difficulties, there is limited objective data quantifying the impact of obesity on intraoperative complications. This study utilizes the CLASSIntra classification system to assess the incidence and severity of iAEs in patients with obesity (BMI ≥ 30 kg/m2) undergoing rectal cancer resection.

The aim was to evaluate the association of neoadjuvant therapy with increases in the incidence of anastomotic leakage (AL) after middle and low rectal anterior resection.The electronic databases of PubMed, Web of Science, Scopus and Ovid were searched between 1980 and 2015. The random effects model was used to model the pooled data to determine the odds ratio with 95% confidence interval. Heterogeneity was evaluated using the Q test and I statistics. Subgroup, sensitivity and meta-regression analysis was conducted to explore heterogeneity.Neoadjuvant therapy was not shown to increase the incidence of postoperative AL as demonstrated by an OR of 1.16 [95% CI 0.99-1.36; P = 0.07 (random effects model)]. The subgroup analysis of neoadjuvant radiotherapy using the random effects model suggested that it did not increase the rate of postoperative AL (OR = 1.24, 95% CI 0.97-1.58; P = 0.08). The subgroup analysis of neoadjuvant chemoradiotherapy indicated that the rate of postoperative AL again did not increase with an OR = 1.06 [95% CI 0.86-1.30; P = 0.59 (random effects model)]. The interval to surgery after neoadjuvant therapy and preoperative radiotherapy (short or long course) was not associated with an increased incidence of postoperative AL.Neoadjuvant therapy does not appear to increase the incidence of postoperative AL after anterior resection for mid and low rectal cancer. In addition, neither the interval to surgery after neoadjuvant therapy nor the radiotherapy regimen increases the rate of postoperative AL.Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

Despite advances in coloanal anastomosis techniques, satisfactory procedures completed without complications remain lacking. We investigated the effectiveness of our recently developed 'Short stump and High anastomosis Pull-through' (SHiP) procedure for delayed coloanal anastomosis without a stoma. In this retrospective study, we analysed functional outcomes, morbidity, and mortality rates and local recurrence of 37 patients treated using SHiP procedure, out of the 282 patients affected by rectal cancer treated in our institution between 2012 and 2020. The inclusion criterion was that the rectal cancer be located within 4 cm from the anal margin. One patient died of local and pulmonary recurrence after 6 years, one developed lung and liver metastases after 2 years, and one experienced local recurrence 2.5 years after surgery. No major leak, retraction, or ischaemia of the colonic stump occurred; the perioperative mortality rate was zero. Five patients (13.51%) had early complications. Stenosis of the anastomosis, which occurred in nine patients (24.3%), was the only long-term complication; only three (8.1%) were symptomatic and were treated with endoscopic dilation. The mean Wexner scores at 24 and 36 months were 8.3 and 8.1 points, respectively. At the 36-month check-up, six patients (24%) had major LARS, ten (40%) had minor LARS, and nine (36%) had no LARS. The functional results in terms of LARS were similar to those previously reported after immediate coloanal anastomosis with protective stoma. The SHiP procedure resulted in a drastic reduction in major complications, and none of the patients had a stoma.

Turnbull and Cutait described abdominoperineal pull-through followed by delayed coloanal anastomosis (DCA) in 1961. DCA could reduce anastomotic leaks, pelvic morbidity and use of stomas. Strong evidence about its clinical benefits is still lacking. This systematic review examined the clinical outcomes of DCA for the treatment of malignant or benign colorectal conditions. A systematic search of electronic medical databases was conducted. Two independent reviewers selected studies, extracted data and assessed risk of bias. The primary outcome was pelvic morbidity (anastomotic leak, pelvic abscess or sepsis, use of stoma). Fecal continence and survival data were also analyzed. From 1,251 citations, we included seven observational studies including 1,124 patients. All included studies were considered at high risk of bias. Two studies comparing DCA with immediate anastomosis reported a significant decrease in anastomotic leak, and pelvic abscess or sepsis. Low rates of pelvic morbidity were reported in the other five studies: anastomotic leak 0-7 %, pelvic abscess 0-11.8 % and pelvic sepsis 6.8-10 %. Rates of permanent stoma after DCA were low in six studies (1-6 %), with one study reporting an incidence of 25 %. Fecal continence was reported as satisfying in all studies. No differences were observed in a comparative setting. Survival data were reported in four studies. Clinical heterogeneity and methodological issues precluded meta-analysis. Based on retrospective evidence, DCA offers a low rate of anastomotic leak, pelvic morbidity and use of stoma, with reasonable fecal continence. Results are encouraging, but prospective studies are needed for comparison with standard of care.

Increased operative time in colorectal surgery is associated with worse surgical outcomes. Laparoscopic and robotic operations have improved outcomes, despite longer operative times. Furthermore, the definition of “prolonged” operative time has not been consistently defined.