Laparoscopic delayed coloanal anastomosis without diverting ileostomy for low rectal cancer surgery: 85 consecutive patients from a single institution
Résumé
BACKGROUND:
Surgical treatment for low rectal cancer septic complications often requires an ileostomy for fecal diversion. Delayed coloanal anastomosis (CAA) has been performed for several years to reduce septic complications and to avoid ileostomy. The aim of this study was to report the technical, functional and oncological results of delayed CAA in patients operated on for low rectal cancer focusing on pelvic septic complications.
METHODS:
All consecutive patients operated on for low rectal cancer suitable for total mesorectal excision and two-step delayed CAA at a single institution between May 2000 and September 2013 were included in the study. Patients' characteristics, operative and postoperative outcomes, long-term technical, functional and oncological results from a prospectively maintained database, were retrospectively analyzed.
RESULTS:
A total of 85 consecutive patients (69 men), of median age 63 years (range 42-83 years) were included. Median delay between the first and the second step of the operation was 6 days (range 2-13 days). Twenty-one patients (25%) developed pelvic sepsis, nine of them (10.6%) developed an anastomotic leak. Twenty-three patients had a definitive stoma at the end of follow-up. Seventeen patients (29%) experienced a poor functional result. Thirty-three patients (38%) presented with recurrence at a median follow-up of 59 months (range 12-135 months). Seven (8.2%) developed a local recurrence, 18 a distant metastasis (21.1%) and 8 (9.4%) both a local and distant recurrence.
CONCLUSIONS:
In our series, laparoscopic total mesorectal excision with delayed coloanal anastomosis was associated with septic complications and oncologic results similar to those reported after total mesorectal excision with conventional anastomosis and ileostomy, nearly one-third of patients experience a poor functional result. A randomized trial comparing these two options for low rectal cancer is under way.