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Delayed Colo-anal Anastomosis for Rectal Cancer: Pelvic Morbidity, Functional Results and Oncological Outcomes: A Systematic Review

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Abstract

Background

Delayed colo-anal anastomosis (DCAA) has received renewed interest thanks to its reduction in anastomotic leakage rate without the use of stoma to protect a low rectal anastomosis. The aim of this review was to summarize the available literature on DCAA following rectal cancer resection and to report clinical, oncological and functional results.

Methods

A comprehensive literature review was conducted including MEDLINE/Pubmed, EMBASE, SCOPUS, clinicaltrials.gov and the Cochrane database of systematic reviews through July 2018. The review was conducted according to MOOSE guidelines. Quality was appraised with the methodological index for non-randomized studies (MINORS) tool.

Results

Eight observational studies (409 patients) were included. Average MINORS score was 9.6/14 in seven non-comparative studies and 17/22 in one comparative study. Six studies reported no anastomotic leak. Pelvic sepsis/abscess ranged from 0 to 25%. Mortality rate was <3% in seven studies and 12.5% in one. Poor fecal continence was reported in <30% of patients. Need for permanent stoma was ≤2% in six studies. A five-year survival rate ranged from 63.8 to 81% (four studies). Loco-regional recurrence rate ranged from 4.8 to 14.3% at 3 years (four studies) and from 6 to 38.8% at 5 years (three studies).

Conclusion

DCAA offers an alternative to primary straight colo-anal anastomosis for low rectal cancer. The benefits include reduced risk of anastomotic leakage and pelvic sepsis, and no need for protective ileostomy, with good functional and oncological outcomes. Results of ongoing randomized controlled trials comparing DCAA with straight colo-anal anastomosis and protective stoma are awaited to draw definitive conclusions.

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Author information

Authors and Affiliations

  1. Department of General Surgery, Azienda ULSS 6, Cittadella, Via Casa di Ricovero 40, 35013, Cittadella, Padova, Italy

    Giuseppe Portale

  2. Department of General and Visceral Surgery, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany

    George Octavian Popesc

  3. Department of Anesthesia and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada

    Matteo Parotto

  4. Independent Statistician, Solagna, Italy

    Francesco Cavallin

Authors
  1. Giuseppe Portale
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  2. George Octavian Popesc
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  3. Matteo Parotto
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  4. Francesco Cavallin
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Contributions

GP, GOP, FC were involved in conception and design. GP, MP, FC contributed to the acquisition of data. GP, GOP, MP, FC analyzed and interpreted the data. GP, GOP, MP, FC drafted the manuscript. GP and FC revised the manuscript.

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Correspondence to Giuseppe Portale.

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Portale, G., Popesc, G.O., Parotto, M. et al. Delayed Colo-anal Anastomosis for Rectal Cancer: Pelvic Morbidity, Functional Results and Oncological Outcomes: A Systematic Review. World J Surg 43, 1360–1369 (2019). https://doi.org/10.1007/s00268-019-04918-y

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