Turnbull-Cutait pull-through coloanal anastomosis versus standard coloanal anastomosis plus diverting ileostomy for low anterior resection: a meta-analysis and systematic review.

Autor: Pompeu BF; Department of Colorectal Surgery, Heliopolis Hospital, São Paulo, Brazil. bernardo.pompeu@online.uscs.edu.br.; USCS - University of São Caetano do Sul, Rua Santo Antônio, 50 - Centro, São Caetano do Sul, SP, 09521-160, Brazil. bernardo.pompeu@online.uscs.edu.br., Pasqualotto E; Federal University of Santa Catarina, Florianópolis, Brazil., Pigossi BD; Department of Colorectal Surgery, Heliopolis Hospital, São Paulo, Brazil., Marcolin P; Federal University of the Southern Border, Chapecó, Brazil., de Figueiredo SMP; Department of Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA., Bin FC; Department of Colorectal Surgery, Medical Science College of Santa Casa de São Paulo, São Paulo, Brazil., Formiga FB; Department of Colorectal Surgery, Heliopolis Hospital, São Paulo, Brazil.; Department of Colorectal Surgery, Medical Science College of Santa Casa de São Paulo, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: Langenbeck's archives of surgery [Langenbecks Arch Surg] 2024 Jun 18; Vol. 409 (1), pp. 187. Date of Electronic Publication: 2024 Jun 18.
DOI: 10.1007/s00423-024-03379-9
Abstrakt: Purpose: Coloanal anastomosis with loop diverting ileostomy (CAA) is an option for low anterior resection of the rectum, and Turnbull-Cutait coloanal anastomosis (TCA) regained popularity in the effort to offer patients a reconstructive option. In this context, we aimed to compare both techniques.
Methods: PubMed, Cochrane, and Scopus were searched for studies published until January 2024. Odds ratios (RRs) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the Cochran Q test and I 2 statistics, with p-values inferior to 0.10 and I 2 >25% considered significant. Statistical analysis was conducted in RStudio version 4.1.2 (R Foundation for Statistical Computing). Registered number CRD42024509963.
Results: One randomized controlled trial and nine observational studies were included, comprising 1,743 patients, of whom 899 (51.5%) were submitted to TCA and 844 (48.5%) to CAA. Most patients had rectal cancer (52.2%), followed by megacolon secondary to Chagas disease (32.5%). TCA was associated with increased colon ischemia (OR 3.54; 95% CI 1.13 to 11.14; p < 0.031; I 2 = 0%). There were no differences in postoperative complications classified as Clavien-Dindo ≥ IIIb, anastomotic leak, pelvic abscess, intestinal obstruction, bleeding, permanent stoma, or anastomotic stricture. In subgroup analysis of patients with cancer, TCA was associated with a reduction in anastomotic leak (OR 0.55; 95% CI 0.31 to 0.97 p = 0.04; I 2 = 34%).
Conclusion: TCA was associated with a decrease in anastomotic leak rate in subgroups analysis of patients with cancer.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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