Peri-Operative Outcomes of Abdominotransanal Resection with Total Mesorectal Excision and Coloanal Anastomosis for Primary Distal Rectal Adenocarcinoma

Abstract

Background: This study aimed to provide a local report on the perioperative outcomes as well as the factors that contribute to the development of complications on patients with primary distal rectal cancer who underwent abdomino-transanal resection (ATAR) with total mesorectal excision (TME) and transanal handsewn coloanal anastomosis (CAA). Methods: This retrospective study was conducted by the Division of Colorectal Surgery of the Philippine General Hospital which evaluated 79 adult patients who underwent ATAR with TME and CAA due to primary distal rectal adenocarcinoma from January 1, 2008 to December 31, 2010. The variables such as age, gender, comorbidities, pre-operative serum albumin level, smoking history, utilization of neoadjuvant therapy, distance of tumor from anal verge, surgical approach, quality of surgical specimen, circumferential resection margin, pathologic stage, length of postoperative hospital stay, type of anesthesia, morbidity and mortality were recorded and analyzed. Results: Of the 79 patients, 19 patients (24.05%) had reported CAA dehiscence, 3 patients (3.8%) necessitated a relaparotomy with drainage of generalized intra-abdominal abscess, 6 (7.59%) patients underwent transanal drainage of pelvic abscess and 10 (12.66%) patients who presented with pelvic abscess on computed tomography scan (3), purulent discharge with minor coloanal anastomotic disruption (3) and fistula (4) were managed nonoperatively. Diabetes mellitus (P=0.043) and history of smoking (P=0.037) were found to be statistically significant factors associated with increased incidence of CAA dehiscence. Conclusion: Diabetes mellitus and history of smoking lead to statistically significant increase in the development of anastomotic dehiscence following ATAR with TME and CAA for primary distal rectal cancer. Key words: abdominotransanal resection, low anterior resection, coloanal anastomosis, rectal cancer