Delayed vs Immediate Coloanal Anastomosis after Total Mesorectal Excision for Low Rectal Cancer: An International Multicenter Retrospective Cohort Study.

Abstract

Despite increasing interest in Turnbull-Cutait pull-through delayed coloanal anastomosis (DCAA) for low rectal cancer, its advantages over conventional immediate coloanal anastomosis (ICAA) with a diverting stoma remain unclear. This study aimed to compare postoperative outcomes between DCAA and ICAA after elective total mesorectal excision for low rectal cancer. This international, multicenter, retrospective cohort study included patients who underwent elective minimally invasive total mesorectal excision with hand-sewn coloanal anastomosis (ICAA or DCAA) for primary low rectal adenocarcinoma. The primary outcome was the overall 30-day postoperative complication rate. Postoperative anorectal function was assessed using the low anterior resection syndrome and Wexner scores 1 and 2 years postoperatively. A total of 305 consecutive patients (109 delayed and 196 immediate) were assessed. The overall 30-day postoperative complication rate was 25%, with a significantly lower incidence in the DCAA group compared with the ICAA group (15% vs 31%, p = 0.002). Both early (within 30 days) and late (after 30 days) anastomosis-related complications were significantly lower in the DCAA group than that in the ICAA group, at 7% vs 15%, p = 0.047, and 2% vs 11%, p = 0.005, respectively. Two years postoperatively, the DCAA cohort had a significantly lower proportion of patients with major low anterior resection syndrome (38% vs 60%, p = 0.018) and severe incontinence (0% vs 8%, p = 0.029). DCAA without a diverting stoma for low rectal cancer removes the risks associated with stoma creation and closure-related morbidity. DCAA is also linked to significantly lower postoperative morbidity and improved anorectal function at 2 years compared with ICAA with a diverting stoma. DCAA may therefore be the optimal anastomotic method for patients with low rectal cancer.