Is Delaying a Coloanal Anastomosis the Ideal Solution for Rectal Surgery

Abstract

Objectives: To assess the specific results of delayed coloanal anastomosis (DCAA) in light of its two main indications. Summary Background Data: 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). Methods: All patients who underwent DCAA intervention at 30 GRECCAR-affiliated hospitals between 2010 and 2021 were retrospectively included. Results: 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. Conclusions: 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.