Is Delaying a Coloanal Anastomosis the Ideal Solution for Rectal Surgery?

Author:

Collard Maxime K.1,Rullier Eric2,Tuech Jean-Jacques3,Sabbagh Charles4,Souadka Amine5,Loriau Jérome6,Faucheron Jean-Luc7,Benoist Stéphane8,Dubois Anne9,Dumont Frédéric10,Germain Adeline11,Manceau Gilles12,Marchal Frédéric13,Sourrouille Isabelle14,Lakkis Zaher15,Lelong Bernard16,Derieux Simon17,Piessen Guillaume18,Laforest Anaïs19,Venara Aurélien20,Prudhomme Michel21,Brigand Cécile22,Duchalais Emilie23,Ouaissi Mehdi24,Lebreton Gil25,Rouanet Philippe26,Mège Diane27,Pautrat Karine28,Reynolds Ian S.29,Pocard Marc30,Parc Yann1,Denost Quentin31,Lefevre Jérémie H.1,

Affiliation:

1. Department of Colorectal Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne University, Paris, France

2. Department of General and Digestive Surgery, Saint André Hospital, Bordeaux, France

3. Department of General and Digestive Surgery, Hospital Charles Nicole, Rouen, France

4. Department of General and Digestive surgery, Amiens Hospital, France

5. Department of General and Digestive surgery, National Institute of Oncology, Rabat, Marocco

6. Department of Digestive Surgery, Saint-Joseph Hospital, Paris, France

7. Department of Colorectal Surgery, Hôpital Unversitaire de Grenoble, France

8. Department of General and Digestive surgery, Hôpital du Kremlin-Bicêtre, Kremlin-Bicêtre, France

9. Department of General and Digestive surgery, CHU Clermont-Ferrand Site Estaing, Clermont-Ferrand, France

10. Department of General and Digestive Surgery, Institut de cancérologie de l’ouest, Saint-Herblain, France

11. Department of General and Digestive Surgery, Hôpital Universitaire de Nancy, France

12. Department of General and Digestive Surgery, Hôpital Européen Georges Pompidou, Paris, France

13. Department of Surgical Oncology, Institut de Cancérologie de Lorraine, Université de Lorraine, Vandoeuvre-les-Nancy, France

14. Department of Anesthesiology, Surgery and Interventional, Villejuif, France

15. Department of Digestive Surgery, University Hospital of Besancon, Besancon, France

16. Department of General and Digestive Surgery, Institute Paoli-Calmettes, Marseille, France

17. Department of General and Digestive Surgery, Groupe Hospitalier Diaconesses—Croix Saint Simon, Paris, France

18. Department of General and Digestive Surgery, Hôpital Huriez, Lille, France

19. Department of General and Digestive Surgery, Institute Monsouris, Paris, France

20. Department of General and Digestive Surgery, Hôpital Universitaire d’Angers, France

21. Department of General and Digestive Surgery, Hôpital Universitaire de Nîmes, France

22. Department of General and Digestive Surgery, Hôpital de Hautepierre—Hôpitaux Universitaires, Strasbourg, France

23. Department of General and Digestive Surgery, Centre Hospitalier Universitaire de Nantes, France

24. Department of General and Digestive Surgery, Hôpital Trousseau - CHRU Hôpitaux de Tours, Chambray-lès-Tours, France

25. Department of General and Digestive Surgery, CHU côte de Nâcre, Caen, France

26. Department of General and Digestive Surgery, Institut du Cancer de Montpellier, Montpellier, France

27. Department of General and Digestive Surgery, Hôpital de la Timone, Marseille, France

28. Department of General and Digestive Surgery, Hôpital Lariboisière, Paris, France

29. Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland

30. Department of General and Digestive Surgery, Hôpital Pitié-Salpêtrère, Paris, France

31. Department of General and Digestive Surgery, Bordeaux Colorectal Institute, Bordeaux, France

Abstract

Objectives: To assess the specific results of delayed coloanal anastomosis (DCAA) in light of its 2 main indications. Background: DCAA can be proposed either immediately after a low anterior resection (primary DCAA) or after the failure of a primary pelvic surgery as a salvage procedure (salvage DCAA). Methods: All patients who underwent DCAA intervention at 30 GRECCAR-affiliated hospitals between 2010 and 2021 were retrospectively included. Results: Five hundred sixty-four patients (male: 63%; median age: 62 years; interquartile range: 53–69) underwent a DCAA: 66% for primary DCAA and 34% for salvage DCAA. Overall morbidity, major morbidity, and mortality were 57%, 30%, and 1.1%, respectively, without any significant differences between primary DCAA and salvage DCAA (P = 0.933; P = 0.238, and P = 0.410, respectively). Anastomotic leakage was more frequent after salvage DCAA (23%) than after primary DCAA (15%), (P = 0.016). Fifty-five patients (10%) developed necrosis of the intra-abdominal colon. In multivariate analysis, intra-abdominal colon necrosis was significantly associated with male sex [odds ratio (OR) = 2.67 95% CI: 1.22–6.49; P= 0.020], body mass index >25 (OR = 2.78 95% CI: 1.37–6.00; P = 0.006), and peripheral artery disease (OR = 4.68 95% CI: 1.12–19.1; P = 0.030). The occurrence of this complication was similar between primary DCAA (11%) and salvage DCAA (8%), (P = 0.289). Preservation of bowel continuity was reached 3 years after DCAA in 74% of the cohort (primary DCAA: 77% vs salvage DCAA: 68%, P = 0.031). Among patients with a DCAA mannered without diverting stoma, 75% (301/403) have never required a stoma at the last follow-up. Conclusions: DCAA makes it possible to definitively avoid a stoma in 75% of patients when mannered initially without a stoma and to save bowel continuity in 68% of the patients in the setting of failure of primary pelvic surgery.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Surgery

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