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The clinical results of the Turnbull–Cutait delayed coloanal anastomosis: a systematic review

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Abstract

Turnbull and Cutait described abdominoperineal pull-through followed by delayed coloanal anastomosis (DCA) in 1961. DCA could reduce anastomotic leaks, pelvic morbidity and use of stomas. Strong evidence about its clinical benefits is still lacking. This systematic review examined the clinical outcomes of DCA for the treatment of malignant or benign colorectal conditions. A systematic search of electronic medical databases was conducted. Two independent reviewers selected studies, extracted data and assessed risk of bias. The primary outcome was pelvic morbidity (anastomotic leak, pelvic abscess or sepsis, use of stoma). Fecal continence and survival data were also analyzed. From 1,251 citations, we included seven observational studies including 1,124 patients. All included studies were considered at high risk of bias. Two studies comparing DCA with immediate anastomosis reported a significant decrease in anastomotic leak, and pelvic abscess or sepsis. Low rates of pelvic morbidity were reported in the other five studies: anastomotic leak 0–7 %, pelvic abscess 0–11.8 % and pelvic sepsis 6.8–10 %. Rates of permanent stoma after DCA were low in six studies (1–6 %), with one study reporting an incidence of 25 %. Fecal continence was reported as satisfying in all studies. No differences were observed in a comparative setting. Survival data were reported in four studies. Clinical heterogeneity and methodological issues precluded meta-analysis. Based on retrospective evidence, DCA offers a low rate of anastomotic leak, pelvic morbidity and use of stoma, with reasonable fecal continence. Results are encouraging, but prospective studies are needed for comparison with standard of care.

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Authors and Affiliations

  1. Department of Surgery, Université Laval, Quebec, QC, Canada

    J. Hallet, H. Milot, S. Drolet, E. Desrosiers, R. C. Grégoire & A. Bouchard

  2. Department of Surgery, Centre Hospitalier Universitaire de Québec (CHUQ), Quebec, QC, Canada

    S. Drolet, R. C. Grégoire & A. Bouchard

  3. 610 University Avenue, Room 3-120, Toronto, ON, M5G 2M9, Canada

    J. Hallet

Authors
  1. J. Hallet
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Corresponding author

Correspondence to J. Hallet.

Appendices

Appendix 1: Search strategy for medline (1966-October 2011)

  1. 1.

    Abdominoperineal pull-through

  2. 2.

    Delayed coloanal anastomosis

  3. 3.

    Delayed colorectal anastomosis

  4. 4.

    Turnbull–Cutait

  5. 5.

    Cutait

  6. 6.

    Endoanal pull-through resection

  7. 7.

    Salvage therapy

  8. 8.

    Salvage therapy (mesh)

  9. 9.

    1 OR 2 OR 3 OR 4 OR 5 OR 6 OR 7 OR 8

  10. 10.

    Rectal resection

  11. 11.

    Abdominoperineal resection

  12. 12.

    Diverting stoma

  13. 13.

    Covering stoma

  14. 14.

    Immediate coloanal anastomosis

  15. 15.

    Total mesorectal excision

  16. 16.

    Surgical stoma (mesh)

  17. 17.

    Suture technique (mesh)

  18. 18.

    10 OR 11 OR 12 OR 13 OR 14 OR 15 OR 16 OR 17

  19. 19.

    Rectal cancer

  20. 20.

    Anorectal disease

  21. 21.

    Anastomotic leak

  22. 22.

    Pelvic abscess

  23. 23.

    Abdominal abscess

  24. 24.

    Fistula

  25. 25.

    Rectovaginal fistula

  26. 26.

    Rectal neoplasm (mesh)

  27. 27.

    Rectal tumor (mesh)

  28. 28.

    Rectal cancer (mesh)

  29. 29.

    Fistula (mesh)

  30. 30.

    Rectal fistula (mesh)

  31. 31.

    Rectovaginal fistula (mesh)

  32. 32.

    Abscess, intra-abdominal (mesh)

  33. 33.

    Anastomosis, surgical (mesh)

  34. 34.

    Anastomotic leak (mesh)

  35. 35.

    19 OR 20 OR 21 OR 22 OR 23 OR 24 OR 25 OR 26 OR 27 OR 28 OR 39 OR 30 OR 31 OR 32 OR 33 OR 34

  36. 36.

    9 AND 18 AND 35

  37. 37.

    Humans (mh)

  38. 38.

    36 AND 37

Appendix 2: Associations considered for meetings’ proceedings review

General surgery

Colorectal surgery

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Hallet, J., Milot, H., Drolet, S. et al. The clinical results of the Turnbull–Cutait delayed coloanal anastomosis: a systematic review. Tech Coloproctol 18, 579–590 (2014). https://doi.org/10.1007/s10151-014-1132-1

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  • DOI: https://doi.org/10.1007/s10151-014-1132-1

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