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Hand‐sewn coloanal anastomosis for low rectal cancer: technique and long‐term outcome
Author(s) -
Tekkis P.,
Tan E.,
Kontovounisios C.,
Kinross J.,
Georgiou C.,
Nicholls R. J.,
Rasheed S.,
Brown G.
Publication year - 2015
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.13028
Subject(s) - medicine , coloanal anastomosis , surgery , rectum , anastomosis , colorectal cancer , total mesorectal excision , fistula , anal canal , cancer
Aim This study compared the operative outcome and long‐term survival of three types of hand‐sewn coloanal anastomosis (CAA) for low rectal cancer. Method Patients presenting with low rectal cancer at a single centre between 2006 and 2014 were classified into three types of hand‐sewn CAA: type 1 ( supra ‐anal tumours undergoing transabdominal division of the rectum with transanal mucosectomy); type 2 (juxta‐anal tumours, undergoing partial intersphincteric resection); and type 3 (intra‐anal tumours, undergoing near‐total intersphincteric resection with transanal mesorectal excision). Results Seventy‐one patients with low rectal cancer underwent CAA: 17 type 1; 39 type 2; and 15 type 3. The median age of patients was 61.6 years, with a male/female ratio of 2:1. Neoadjuvant therapy was given to 56 (79%) patients. R0 resection was achieved in 69 (97.2%) patients. Adverse events occurred in 25 (35.2%) of the 71 patients with a higher complication rate in type 1 vs type 2 vs type 3 (47.1% vs 38.5% vs 13.3%, respectively; P = 0.035). Anastomotic separation was identified in six (8.5%) patients and pelvic haematoma/seroma in five (7%); two (8.3%) female patients developed a recto–vaginal fistula. Ten (14.1%) patients were indefinitely diverted, with a trend towards higher long‐term anastomotic failure in type 1 vs type 2 vs type 3 (17.6% vs 15.5% vs 6.7%). The type of anastomosis did not influence the overall or disease‐free survival. Conclusion CAA is a safe technique in which anorectal continuity can be preserved either as a primary restorative option in elective cases of low rectal cancer or as a salvage procedure following a failed stapled anastomosis with a less successful outcome in the latter. CAA has acceptable morbidity with good long‐term survival in carefully selected patients.