Kitaguchi Daichi, Seow-En Isaac, Shen Ming-Yin, Ke Tao-Wei, Kim Ji-Seon, Kim Jin, Ito Masaaki, Chen William Tzu-Liang
From the Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan (Kitaguchi, Ito).
Department of Colorectal Surgery, Singapore General Hospital, Singapore (Seow-En).
J Am Coll Surg. 2025 Sep 1;241(3):448-459. doi: 10.1097/XCS.0000000000001410. Epub 2025 Aug 14.
Despite increasing interest in Turnbull-Cutait pull-through delayed coloanal anastomosis (DCAA) for low rectal cancer, its advantages over conventional immediate coloanal anastomosis (ICAA) with a diverting stoma remain unclear. This study aimed to compare postoperative outcomes between DCAA and ICAA after elective total mesorectal excision for low rectal cancer.
This international, multicenter, retrospective cohort study included patients who underwent elective minimally invasive total mesorectal excision with hand-sewn coloanal anastomosis (ICAA or DCAA) for primary low rectal adenocarcinoma. The primary outcome was the overall 30-day postoperative complication rate. Postoperative anorectal function was assessed using the low anterior resection syndrome and Wexner scores 1 and 2 years postoperatively.
A total of 305 consecutive patients (109 delayed and 196 immediate) were assessed. The overall 30-day postoperative complication rate was 25%, with a significantly lower incidence in the DCAA group compared with the ICAA group (15% vs 31%, p = 0.002). Both early (within 30 days) and late (after 30 days) anastomosis-related complications were significantly lower in the DCAA group than that in the ICAA group, at 7% vs 15%, p = 0.047, and 2% vs 11%, p = 0.005, respectively. Two years postoperatively, the DCAA cohort had a significantly lower proportion of patients with major low anterior resection syndrome (38% vs 60%, p = 0.018) and severe incontinence (0% vs 8%, p = 0.029).
DCAA without a diverting stoma for low rectal cancer removes the risks associated with stoma creation and closure-related morbidity. DCAA is also linked to significantly lower postoperative morbidity and improved anorectal function at 2 years compared with ICAA with a diverting stoma. DCAA may therefore be the optimal anastomotic method for patients with low rectal cancer.
尽管对Turnbull-Cutait拖出式延迟结肠肛管吻合术（DCAA）治疗低位直肠癌的兴趣日益增加，但其相较于带转流造口的传统即时结肠肛管吻合术（ICAA）的优势仍不明确。本研究旨在比较低位直肠癌选择性全直肠系膜切除术后DCAA与ICAA的术后结局。
这项国际多中心回顾性队列研究纳入了因原发性低位直肠腺癌接受选择性微创全直肠系膜切除并手工缝合结肠肛管吻合术（ICAA或DCAA）的患者。主要结局是术后30天总体并发症发生率。术后1年和2年使用低位前切除综合征和Wexner评分评估肛门直肠功能。
共评估了305例连续患者（109例延迟组和196例即时组）。术后30天总体并发症发生率为25%，DCAA组的发生率显著低于ICAA组（15%对31%，p = 0.002）。DCAA组早期（30天内）和晚期（30天后）吻合口相关并发症均显著低于ICAA组，分别为7%对15%，p = 0.047，以及2%对11%，p = 0.005。术后两年，DCAA队列中出现严重低位前切除综合征的患者比例显著更低（38%对60%，p = 0.018），且严重失禁的患者比例也更低（0%对8%，p = 0.029）。
低位直肠癌采用无转流造口的DCAA可消除造口相关风险以及造口关闭相关的发病率。与带转流造口的ICAA相比，DCAA还与术后两年显著更低的发病率以及改善的肛门直肠功能相关。因此，DCAA可能是低位直肠癌患者的最佳吻合方法。
