Delayed coloanal anastomosis: an alternative option for restorative rectal cancer surgery after high‐dose pelvic radiotherapy for prostate cancer

Abstract

Aim Restorative total mesorectal excision (TME) for rectal cancer after high-dose pelvic radiotherapy for prostate cancer has been reported to provide an unacceptable rate of pelvic sepsis. In a previous publication we proposed that delayed coloanal anastomosis (DCAA) should be performed in this situation. The present study aimed to assess the feasibility and outcomes of this strategy. Method Between 2000 and 2018, 1094 men were operated on for rectal cancer in our institution. All men with T2/T3 mid and low rectal cancer with preoperative radiotherapy and restorative TME were considered for this study (n = 416). Patients with external-beam high-dose radiotherapy (EBHRT) for prostate cancer (70-78 Gy) were identified and compared with patients with conventional long-course chemoradiotherapy (CRT) followed by TME. We compared our already published historical cohort (2000-2012), including arm A (CRT + TME; n = 236) and arm B (EBHRT + TME; n = 12), with our early cohort (2013-2018), including arm C (CRT + TME; n = 158) and arm D (EBHRT + TME-DCAA; n = 10). The end-points were morbidity, pelvic sepsis, reoperation rate and quality of the specimen. Results Overall morbidity was not significantly different between groups. Pelvic sepsis decreased from 50% (arm B) to 10% (arm D) with the use of DCAA (P = 0.074), and was similar between arms A, C and D. Quality of the specimen was not significantly different between the four groups. Conclusion Our results suggest that TME with DCAA in patients with previous EBHRT is feasible, with the same postoperative pelvic sepsis rate as conventional CRT.

Is it safe to perform an anastomosis for rectal cancer after prostate cancer? A multicentre study of 126 patients from the GRECCAR group

“…Analysing separately each surgical technique, AL rates after mechanical colorectal anastomosis, anastomotic leak rate after coloanal anastomosis and delayed coloanal anastomosis were respectively 21%, 29% and 0% ( p = 0.16). This observation corroborates with other studies evaluating different types of RS after rectal resection in patients with previously treated PC especially using RT [16]. Nevertheless, albeit the largest series of patients, the current study still lacks power to reach statistical difference in comparing delayed coloanal anastomosis to primary colorectal or coloanal anastomosis.…”

“…In types of RS after rectal resection in patients with previously treated PC especially using RT [16]. Nevertheless, albeit the largest series of patients, the current study still lacks power to reach statistical difference in comparing delayed coloanal anastomosis to primary colorectal or coloanal anastomosis.…”

“…Regarding the available literature focused on RS in the setting of previously treated PC, three other studies have been recently published reporting AL rates ranging from 10% to 62.5% [15,16,25]. While these results are quite conflicting, this raises the question of the heterogeneity between these cohort studies.…”

“…Regarding the available literature focused on RS in the setting of previously treated PC, three other studies have been recently published reporting AL rates ranging from 10% to 62.5% [15,16,25].…”

“…Indeed, on a strategical point of view, one can hypothesize that the type of restorative techniques may play a key role in preventing AL in such a challenging setting. Another recent cohort study suggested that rectal resection with delayed coloanal anastomosis might be feasible and safe in patients with previous PC treatment [16]. In an attempt to decrease the morbidity associated with colorectal anastomosis, Cutait and Turnbull both described their experience with an abdominoperineal pull-through and delayed coloanal anastomosis in 1961 [26,27].…”