Delayed colo-anal anastomosis is an alternative to prophylactic diverting stoma after total mesorectal excision for middle and low rectal carcinomas
| Autor: | W. Moreno, Carine Bellera, Jean-Luc Faucheron, Serge Evrard, J. Jarry |
|---|---|
| Přispěvatelé: | Université Bordeaux Segalen - Bordeaux 2, Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Plateforme de génétique moléculaire des cancers d'Aquitaine, Institut Bergonié [Bordeaux], UNICANCER-UNICANCER |
| Rok vydání: | 2011 |
| Předmět: |
Adult
Male medicine.medical_specialty Colon Colorectal cancer Fistula Anal Canal Anastomosis Stoma 03 medical and health sciences 0302 clinical medicine Colon surgery delayed colo-anal anastomosis medicine fistula Humans rectal cancer Aged Retrospective Studies Aged 80 and over total mesorectal excision Rectal Neoplasms business.industry Mortality rate Anastomosis Surgical Surgical Stomas Retrospective cohort study General Medicine Middle Aged medicine.disease Total mesorectal excision digestive system diseases 3. Good health Surgery Oncology proctectomy 030220 oncology & carcinogenesis diverting stoma Female 030211 gastroenterology & hepatology business |
| Zdroj: | EJSO-European Journal of Surgical Oncology EJSO-European Journal of Surgical Oncology, WB Saunders, 2011, 37 (2), pp.127. ⟨10.1016/j.ejso.2010.12.008⟩ |
| ISSN: | 0748-7983 |
| DOI: | 10.1016/j.ejso.2010.12.008 |
| Popis: | Background After total mesorectal excision (TME), a low colorectal or colo-anal anastomosis is usually performed. A prophylactic covering stoma is often used, especially for patients receiving neoadjuvant chemo-radiotherapy. However, morbidity is high, mainly due to anastomotic leakage. Methods From May 2000 to October 2008, patients with middle or low rectal cancer who underwent a trans-anal pull-through procedure after TME were prospectively recorded. No covering stoma was performed in these patients. However, they all underwent a delayed colo-anal anastomosis (DCA), which was performed 6 days following the TME, on average. Both the surgical technique and follow-up were standardised. Patients with T3, T4 and/or N+ cancers were given preoperative radiotherapy. A retrospective analysis was done to assess post-operative mortality, morbidity, and oncologic and functional results. Results One hundred consecutive patients with rectal tumours at a median distance of 5 cm from the anal verge underwent DCA after TME. The 5-year overall and disease-free survival rates were 81% and 66%, respectively. The post-operative mortality rate was 3% and the overall post-operative morbidity rate was 36%, with only 3 anastomotic leakages. After two years, 73% of the patients had good functional outcomes. Conclusion The trans-anal pull-through procedure after TME, followed by DCA seems to be a safe and efficient sphincter-preserving procedure to treat patients with middle or low rectal cancer while avoiding a prophylactic, diverting stoma. |
| Databáze: | OpenAIRE |
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