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. 2022 Apr 25:9:845148.
doi: 10.3389/fsurg.2022.845148. eCollection 2022.

Laparoscopic Proximally Extended Colorectal Resection With Two-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Late Complications of Chronic Radiation Proctopathy

Yanjiong He  1   2 , Zuolin Zhou  1   2 , Xiaoyan Huang  2   3 , Qi Guan  1   2 , Qiyuan Qin  1   2 , Miaomiao Zhu  1   2 , Huaiming Wang  1   2 , Qinghua Zhong  1   2 , Daici Chen  2   4   5 , Hui Wang  1   2 , Lekun Fang  2   4 , Tenghui Ma  1   2
Affiliations

Laparoscopic Proximally Extended Colorectal Resection With Two-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Late Complications of Chronic Radiation Proctopathy

Yanjiong He et al. Front Surg. .

Abstract

Background: Chronic radiation proctopathy (CRP) is a common complication after radiation therapy for pelvic malignancies. Compared with diversion surgery, resection surgery removes the damaged tissue completely to avoid the risks of recurrence and improve patients' outcome. Hence, resection surgery could be an optimal surgical approach when CRP is complicated by late complications. This study aimed to describe a modified surgical procedure of resection surgery and report its preliminary efficacy and safety in treating patients with CRP with late complications.

Methods: We retrospectively reviewed the patients who were diagnosed with CRP with late complications and underwent the modified surgical procedure of laparoscopic proximally extended colorectal resection with two-Stage Turnbull-Cutait pull-through coloanal anastomosis (PE-Bacon) between November 2019 and October 2020 in the Sixth Affiliated Hospital of Sun Yat-sen University.

Results: A total of 15 patients were performed the modified laparoscopic procedure of PE-Bacon, of which 1 patient underwent conversion from laparoscopic to open operation for intraoperative massive hemorrhage. Overall, the major (Clavien-Dindo III-V) postoperative complications occurred in 1 patient, anastomotic leakage was observed in 2 (13.3%) patients, and anastomotic stricture was observed in 4 (26.7%) patients. No patient had to be reoperated and died. Up to now, at the average follow-up of (524.40 ± 108.39) days, the preoperative symptoms of 93.3% (14/15) patients were relieved, with nine patients achieved complete remission, five patients only suffered minor symptoms. Because of the progression of radiation uropathy, one patient still had a vesicovaginal fistula as pre-operative complication. Colostomy reversal has been performed on 8 (53.3%) patients at an average postoperative duration of 299.5 ± 92.68 days, among whom only 2 patients suffered from major Low Anterior Resection Syndrome (LARS) until now.

Conclusions: Laparoscopic PE-Bacon surgery is a safe and feasible surgical procedure for late complications of CRP with low morbidity and high symptom remission rate.

Keywords: PE-Bacon; Turnbull-Cutait pull-through; chronic radiation proctopathy; laparoscopic proximally extended colorectal resection; two-stage coloanal anastomosis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Abdominal phase of the first stage of PE-Bacon procedure. (A) Mark at the proximal site of non-irradiated colon. (B) Incise the mesentery of sigmoid along the sacral promontory. (C) Ligate inferior mesenteric vessels. (D) Expand the Toldt's fascia. (E,F) Mobilize the colon toward the splenic flexure. (G) Dissect the phrenicocolic ligament and splenocolic ligament. (H) Mobilize the rectum.
Figure 2
Figure 2
Perineal phase of PE-Bacon procedure. (A) Expose the anal canal; (B) dissect the rectum at the level of 1 cm from the distal margin of the rectal lesion; (C) dissect the rectum along the intersphinteric plane; (D) pull through the colon and rectum and transect the diseased bowel; (E) first-stage coloanal anastomosis. (F) second-stage coloanal anastomosis.
See this image and copyright information in PMC

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