Tan T J K, Ng S-M, Lee T S Q, Tan E K-W, Seow-En I
Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Tech Coloproctol. 2025 Aug 18;29(1):164. doi: 10.1007/s10151-025-03206-3.
Despite the potential benefits of abdominoperineal pull-through with delayed coloanal anastomosis (DCAA), it is still infrequently performed as a salvage procedure for pelvic anastomotic failure. We aimed to perform a systematic review on the subject to guide practice.
PubMed, Embase and Cochrane were used to identify studies evaluating DCAA for salvage after pelvic surgery from inception to August 2024. Risk of bias assessment was performed using the Newcastle-Ottawa scale. The primary outcome was overall stoma-free survival. Secondary outcomes included hospital length of stay, high-grade postoperative complication rates, 30-day postoperative mortality rates, incidence of redo surgical intervention after DCAA, and postoperative anorectal function.
Five retrospective cohort studies evaluating a total of 97 patients who underwent salvage abdominoperineal pull-through and DCAA were included in this review. All patients had previous pelvic surgery, predominantly proctectomy (n = 84, 86.6%). The most common indication for redo surgery was chronic fistula (n = 62, 63.9%) followed by anastomotic leak or chronic pelvic sepsis (n = 34, 35.1%). The pooled overall stoma-free survival rate across all five studies was 81.4% over a mean 24-month postoperative follow-up duration. The overall incidence of high-grade complications after DCAA was 39.1% (n = 38). Pooled mean length of stay was 17 days. There were no cases of early postoperative death. Pooled rate of repeat surgery across four studies was 11.6% (n = 8). Pooled mean functional scores across three studies indicated minor low anterior resection syndrome at 26 months.
Abdominoperineal pull-through with delayed coloanal anastomosis is a viable option for salvage surgery following pelvic anastomotic complications, with low rates of permanent stoma and acceptable long-term anorectal function.
尽管经腹会阴拖出术联合延迟结肠肛管吻合术（DCAA）有潜在益处，但作为盆腔吻合口失败的挽救手术，其实施频率仍然较低。我们旨在对该主题进行系统评价以指导临床实践。
使用PubMed、Embase和Cochrane数据库检索从建库至2024年8月评估DCAA用于盆腔手术后挽救治疗的研究。采用纽卡斯尔-渥太华量表进行偏倚风险评估。主要结局是无造口总生存率。次要结局包括住院时间、术后高级别并发症发生率、术后30天死亡率、DCAA后再次手术干预的发生率以及术后肛门直肠功能。
本评价纳入了5项回顾性队列研究，共97例接受挽救性经腹会阴拖出术和DCAA的患者。所有患者既往均接受过盆腔手术，主要是直肠切除术（n = 84，86.6%）。再次手术最常见的指征是慢性瘘管（n = 62，63.9%），其次是吻合口漏或慢性盆腔感染（n = 34，35.1%）。在平均24个月的术后随访期内，所有5项研究的汇总无造口总生存率为81.4%。DCAA后高级别并发症的总体发生率为39.1%（n = 38）。汇总平均住院时间为17天。无术后早期死亡病例。4项研究的汇总再次手术率为11.6%（n = 8）。3项研究的汇总平均功能评分显示在26个月时存在轻度低位前切除综合征。
经腹会阴拖出术联合延迟结肠肛管吻合术是盆腔吻合口并发症后挽救手术的可行选择，永久性造口率低，长期肛门直肠功能可接受。
