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Multicenter Study
. 2023 Nov 1;278(5):781-789.
doi: 10.1097/SLA.0000000000006025. Epub 2023 Jul 31.

Is Delaying a Coloanal Anastomosis the Ideal Solution for Rectal Surgery?: Analysis of a Multicentric Cohort of 564 Patients From the GRECCAR

Maxime K Collard  1 , Eric Rullier  2 , Jean-Jacques Tuech  3 , Charles Sabbagh  4 , Amine Souadka  5 , Jérome Loriau  6 , Jean-Luc Faucheron  7 , Stéphane Benoist  8 , Anne Dubois  9 , Frédéric Dumont  10 , Adeline Germain  11 , Gilles Manceau  12 , Frédéric Marchal  13 , Isabelle Sourrouille  14 , Zaher Lakkis  15 , Bernard Lelong  16 , Simon Derieux  17 , Guillaume Piessen  18 , Anaïs Laforest  19 , Aurélien Venara  20 , Michel Prudhomme  21 , Cécile Brigand  22 , Emilie Duchalais  23 , Mehdi Ouaissi  24 , Gil Lebreton  25 , Philippe Rouanet  26 , Diane Mège  27 , Karine Pautrat  28 , Ian S Reynolds  29 , Marc Pocard  30 , Yann Parc  1 , Quentin Denost  31 , Jérémie H Lefevre  1 ; GRECCAR group
Affiliations
Multicenter Study

Is Delaying a Coloanal Anastomosis the Ideal Solution for Rectal Surgery?: Analysis of a Multicentric Cohort of 564 Patients From the GRECCAR

Maxime K Collard et al. Ann Surg. .

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.

Keywords: anastomotic leakage; delayed anastomosis; ileostomy; rectal cancer.

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Conflict of interest statement

The authors report no conflicts of interest.

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