Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy.
Tech Coloproctol. 2022 Aug;26(8):603-613. doi: 10.1007/s10151-022-02601-4. Epub 2022 Mar 28.
Theoretical advantages of Turnbull-Cutait pull-through delayed coloanal anastomosis (DCAA) are a reduced risk of anastomotic leak and therefore avoidance of stoma. Gradually abandoned in favor of immediate coloanal anastomosis (ICAA) with diverting stoma, DCAA has regained popularity in recent years in reconstructive surgery for low RC, especially when combined with minimally invasive surgery (MIS). The aim of this study was to perform the first meta-analysis, exploring the safety and outcomes of DCAA compared to ICAA with protective stoma.
A systematic search of MEDLINE, EMBASE, and CENTRAL and Google Scholar databases was performed for studies published from January 2000 until December 2020. The systematic review and meta-analysis were performed according to the Cochrane Handbook for Systematic Review on Interventions recommendations and Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines.
Out of 2626 studies screened, 9 were included in the systematic review and 4 studies in the meta-analysis. Outcomes included were postoperative complications, pelvic sepsis and risk of definitive stoma. Considering postoperative complications classified as Clavien-Dindo III, no significant difference existed in the rate of postoperative morbidity between DCAA and ICAA (13% versus 21%; OR 1.17; 95% CI 0.38-3.62; p = 0.78; I = 20%). Patients in the DCAA group experienced a lower rate of postoperative pelvic sepsis compared with patients undergoing ICAA with diverting stoma (7% versus 14%; OR 0.37; 95% CI 0.16-0.85; p = 0.02; I = 0%). The risk of definitive stoma was comparable between the two groups (2% versus 2% OR 0.77; 95% CI 0.15-3.85; p = 0.75; I = 0%).
According to the limited current evidence, DCAA is associated with a significant decrease in pelvic sepsis. Further prospective trials focusing on oncologic and functional outcomes are needed.
Turnbull-Cutait 拖出式延迟结肠直肠吻合术（DCAA）的理论优势在于降低吻合口漏的风险，从而避免造口。该术式逐渐被即时结肠直肠吻合术（ICAA）联合预防性造口术取代，但近年来在低位直肠癌的重建手术中，特别是结合微创手术（MIS）时，DCAA 又重新受到欢迎。本研究旨在进行首次荟萃分析，探讨 DCAA 与保护性造口的 ICAA 相比的安全性和结果。
对 2000 年 1 月至 2020 年 12 月期间发表的 MEDLINE、EMBASE 和 CENTRAL 以及 Google Scholar 数据库进行了系统检索。根据 Cochrane 干预系统评价手册和系统评价和荟萃分析（PRISMA）指南进行了系统综述和荟萃分析。
在筛选出的 2626 项研究中，有 9 项研究被纳入系统评价，4 项研究被纳入荟萃分析。观察结果包括术后并发症、盆腔感染和确定性造口的风险。考虑到术后并发症被分类为 Clavien-Dindo III 级，DCAA 和 ICAA 之间术后发病率无显著差异（13%与 21%；OR 1.17；95%CI 0.38-3.62；p=0.78；I=20%）。与接受预防性造口的 ICAA 患者相比，DCAA 组患者的术后盆腔感染发生率较低（7%与 14%；OR 0.37；95%CI 0.16-0.85；p=0.02；I=0%）。两组患者确定性造口的风险相当（2%与 2%；OR 0.77；95%CI 0.15-3.85；p=0.75；I=0%）。
根据目前有限的证据，DCAA 与盆腔感染显著减少相关。需要进一步开展关注肿瘤学和功能结局的前瞻性试验。
