Two-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Low Rectal Cancer

Abstract

for the TURNBULL-BCN Study Group IMPORTANCE Two-stage Turnbull-Cutait pull-through hand-sewn coloanal anastomosis seems to provide benefits in terms of postoperative morbidity compared with standard hand-sewn coloanal anastomosis associated with diverting ileostomy and further ileostomy reversal in patients operated on for low rectal cancer. OBJECTIVE To compare 30-day postoperative and 1-year follow-up results of Turnbull-Cutait pull-through hand-sewn coloanal anastomosis and standard hand-sewn coloanal anastomosis after ultralow rectal resection for rectal cancer. DESIGN, SETTING, AND PARTICIPANTS Multicenter randomized clinical trial. Neither patients nor surgeons were blinded for technique. Patients were recruited in 3 centers,

Surgical Treatment of Low-Lying Rectal Cancer: Updates

“…Sphincter-preserving surgery (SPS) can be indicated when resection with negative CRM and distal resection margins (DRM) can be achieved, and an adequate anal function can be maintained [ 32 , 33 ]. According to the classification described by Rullier et al [ 28 ], SPS can be adapted to the tumor relation to the sphincter complex to achieve a free distal margin of at least 1 cm; for tumors above the anal sphincter complex, the internal sphincter is preserved, and anal mucosectomy is performed above the dentate line (DL).…”

“…For patients with a high risk of AL who refuse to have a protective ileostomy, an alternative CAA can be performed following the Turnbull and Cutait pull-through or delayed CAA [ 32 , 178 ]. In this technique, after rectal resection for SPS, the left colon completely mobilized to be tension-free exteriorized a few centimeters below the anal verge and fixed to perianal skin by 2 stitches and kept in place through the anal canal by the resting pressure of the anal canal ( Fig.…”

“…A delayed hand-sewn CAA is performed at the anal margin level, preserving the adhesions created between the colonic serosa pelvic tissues the anal canal wall contribute to reducing anastomotic leak. This technique reduces the need for diverting ileostomy without increasing postoperative morbidity rates and avoiding the need for permanent stomas in the short term compared with standard CAA with protective ileostomy followed by ileostomy closure [ 32 ]. In a recent systematic review of 8 observational studies (409 patients), with no AL in 6 out of 8 studies, the mortality rate was ≤ 3%, poor fecal continence was reported in < 30% of patients, and the need for permanent stoma was ≤ 2% [ 179 ].…”

Does oncological outcome differ between restorative and nonrestorative low anterior resection in patients with primary rectal cancer?

“…This might facilitate better quality of the specimen obtained by TME if combined with an intersphincteric approach from below. A randomized multicentre trial (46 patients in each arm) compared delayed hand-sewn coloanal anastomosis with immediate hand-sewn coloanal anastomosis with diverting ileostomy [22]. The composite 30-day complication rate (including stoma reversal) was 35% (delayed coloanal anastomosis) vs 45% (immediate coloanal anastomosis plus ileostomy), and not statistically significant, leading the authors to conclude that delayed anastomosis is a safe alternative.…”

Transanal total mesorectal excision (TaTME) with delayed coloanal anastomosis versus TaTME with immediate coloanal anastomosis and temporary diversion in middle and low rectal cancer

“…8 The two-stage Turnbull-Cutait (TC) pull-through delayed coloanal anastomosis was suggested as an alternative approach to reduce the incidence of anastomotic complications without constructing a stoma was suggested. 9 A recent randomized trial concluded that the TC procedure is safe and does not increase the postoperative complication rate as compared with standard coloanal anastomosis with diverting ileostomy; however, it omits the need for a covering stoma along with its related complications. 9 The present study aimed to compare the outcome of TaTME with either immediate anastomosis (IA) and covering ileostomy or TC delayed coloanal anastomosis in terms of anastomotic and overall complications, pathologic, oncologic, and functional outcomes.…”