Trans-anal exteriorisation of colon and delayed colo-anal anastomosis for sphincter preservation in low carcinoma rectum

Pujahari, Aswini Kumar; Anand, Sunil

doi:10.1007/s00384-014-2059-8

Cited by 4 publications

(12 citation statements)

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“…Details on postoperative outcomes are shown in Table 3. Six out of eight studies reported no anastomotic leak [10–12, 14–16]. Pelvic sepsis/abscess ranged from 0 to 25%.…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies [10–14, 16, 17] reported on fecal continence (Table 4). The information was not directly reported in one study [15] but could be retrieved from another paper by the same authors [18] (Table 4).…”

Section: Resultsmentioning

confidence: 99%

“…Evaluation was performed with different scales: Visick Grading System [10], Wexner Continence Score [13, 15, 17], Lyon Scale [11, 12] and Kirwan Grading Scale [16]. One study [14] reported no incontinence without details on functional assessment and follow‐up time. The need for permanent stoma ranged from 0 to 27% (Table 4).…”

Section: Resultsmentioning

confidence: 99%

“…Ultimately, eight observational studies were included in the qualitative synthesis (Fig. 1) [10][11][12][13][14][15][16][17].…”

Section: Study Selectionmentioning

confidence: 99%

“…Patient characteristics of the included studies are reported in Table 1. Seven studies analyzed only rectal cancer patients [10,11,[13][14][15][16][17], while one [12] included a mixed population (70% rectal cancer and 30% other diseases; we extrapolated data for rectal cancer patients only).…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

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Delayed Colo‐anal Anastomosis for Rectal Cancer: Pelvic Morbidity, Functional Results and Oncological Outcomes: A Systematic Review

Portale¹,

Popesc

Parotto

et al. 2019

World j. surg.

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Background Delayed colo-anal anastomosis (DCAA) has received renewed interest thanks to its reduction in anastomotic leakage rate without the use of stoma to protect a low rectal anastomosis. The aim of this review was to summarize the available literature on DCAA following rectal cancer resection and to report clinical, oncological and functional results. Methods A comprehensive literature review was conducted including MEDLINE/Pubmed, EMBASE, SCOPUS, clinicaltrials.gov and the Cochrane database of systematic reviews through July 2018. The review was conducted according to MOOSE guidelines. Quality was appraised with the methodological index for non-randomized studies (MINORS) tool. Results Eight observational studies (409 patients) were included. Average MINORS score was 9.6/14 in seven noncomparative studies and 17/22 in one comparative study. Six studies reported no anastomotic leak. Pelvic sepsis/ abscess ranged from 0 to 25%. Mortality rate was\3% in seven studies and 12.5% in one. Poor fecal continence was reported in \30% of patients. Need for permanent stoma was B2% in six studies. A five-year survival rate ranged from 63.8 to 81% (four studies). Loco-regional recurrence rate ranged from 4.8 to 14.3% at 3 years (four studies) and from 6 to 38.8% at 5 years (three studies). Conclusion DCAA offers an alternative to primary straight colo-anal anastomosis for low rectal cancer. The benefits include reduced risk of anastomotic leakage and pelvic sepsis, and no need for protective ileostomy, with good functional and oncological outcomes. Results of ongoing randomized controlled trials comparing DCAA with straight colo-anal anastomosis and protective stoma are awaited to draw definitive conclusions.

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“…Details on postoperative outcomes are shown in Table 3. Six out of eight studies reported no anastomotic leak [10–12, 14–16]. Pelvic sepsis/abscess ranged from 0 to 25%.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Ultimately, eight observational studies were included in the qualitative synthesis (Fig. 1) [10][11][12][13][14][15][16][17].…”

Section: Study Selectionmentioning

confidence: 99%

Section: Study and Patient Characteristicsmentioning

confidence: 99%

See 3 more Smart Citations

Delayed Colo‐anal Anastomosis for Rectal Cancer: Pelvic Morbidity, Functional Results and Oncological Outcomes: A Systematic Review

Portale¹,

Popesc

Parotto

et al. 2019

World j. surg.

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Surgical outcomes of Turnbull-Cutait delayed coloanal anastomosis with pull-through versus immediate coloanal anastomosis with diverting stoma after total mesorectal excision for low rectal cancer: a systematic review and meta-analysis

et al. 2022

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Delayed coloanal anastomosis as a stoma‐sparing alternative to immediate coloanal anastomosis: A systematic review and meta‐analysis

Lin

Tan

et al. 2021

ANZ Journal of Surgery

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Background: Recent clinical trials have demonstrated favorable outcomes associated with trans-anal colonic pull-through for rectal resection followed by delayed coloanal anastomoses (DCA), resulting in a resurgence in popularity of the technique. This meta-analysis aims to review existing literature to evaluate the postoperative complications associated with DCA, and to make comparisons with immediate coloanal anastomoses (ICA) after colorectal resection to assess the suitability of DCA as an alternative form of surgical treatment. Methods: Medline and Embase databases were reviewed from inception until 31 July 2020 in accordance with PRISMA guidelines. Single-arm studies that involved patients undergoing DCA for benign or malignant causes were selected, and meta-analysis of proportions was conducted to determine the prevalence of postoperative complications following DCA. Comparative studies comparing postoperative outcomes between DCA and ICA were also included for comparative meta-analysis. Results: Patients undergoing DCA were significantly less likely to require diverting stoma construction as compared to ICA (odds ratio [OR] = 0.04; confidence interval [CI]: 0.02-0.07; P < 0.001). Overall postoperative morbidity (OR = 0.50; 95% CI: 0.23-1.12; P = 0.09) and mortality (OR = 0.49, 95% CI: 0.12-1.98; P = 0.32) was comparable between DCA and ICA groups. No significant differences in perioperative complications, such as anastomotic leakage (OR = 0.42; 95% CI: 0.11-1.64; P = 0.21), postoperative ileus, pelvic abscesses, or sepsis, were noted between DCA and ICA. Conclusion: Our study shows no differences in complications or functional outcomes between DCA and ICA. Pooled analysis expectedly revealed a lower rate of diverting stoma in patients undergoing DCA. DCA is thus a safe alternative to current surgical practices where avoidance of a stoma is desired.

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Trans-anal exteriorisation of colon and delayed colo-anal anastomosis for sphincter preservation in low carcinoma rectum

Cited by 4 publications

References 0 publications

Delayed Colo‐anal Anastomosis for Rectal Cancer: Pelvic Morbidity, Functional Results and Oncological Outcomes: A Systematic Review

Delayed Colo‐anal Anastomosis for Rectal Cancer: Pelvic Morbidity, Functional Results and Oncological Outcomes: A Systematic Review

Surgical outcomes of Turnbull-Cutait delayed coloanal anastomosis with pull-through versus immediate coloanal anastomosis with diverting stoma after total mesorectal excision for low rectal cancer: a systematic review and meta-analysis

Delayed coloanal anastomosis as a stoma‐sparing alternative to immediate coloanal anastomosis: A systematic review and meta‐analysis

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