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@article{Tekkis:2015:10.1111/codi.13028,
author = {Tekkis, P and Tan, E and Kontovounisios, C and Kinross, J and Georgiou, C and Nicholls, RJ and Rasheed, S and Brown, G},
doi = {10.1111/codi.13028},
journal = {Colorectal Disease},
pages = {1062--1070},
title = {Hand-sewn coloanal anastomosis for low rectal cancer: technique and long-term outcome},
url = {http://dx.doi.org/10.1111/codi.13028},
volume = {17},
year = {2015}
}

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TY  - JOUR
AB  - AimThis study compared the operative outcome and long-term survival of three types of hand-sewn coloanal anastomosis (CAA) for low rectal cancer.MethodPatients presenting with low rectal cancer at a single centre between 2006 and 2014 were classified into three types of hand-sewn CAA: type 1 (supra-anal tumours undergoing transabdominal division of the rectum with transanal mucosectomy); type 2 (juxta-anal tumours, undergoing partial intersphincteric resection); and type 3 (intra-anal tumours, undergoing near-total intersphincteric resection with transanal mesorectal excision).ResultsSeventy-one patients with low rectal cancer underwent CAA: 17 type 1; 39 type 2; and 15 type 3. The median age of patients was 61.6 years, with a male/female ratio of 2:1. Neoadjuvant therapy was given to 56 (79%) patients. R0 resection was achieved in 69 (97.2%) patients. Adverse events occurred in 25 (35.2%) of the 71 patients with a higher complication rate in type 1 vs type 2 vs type 3 (47.1% vs 38.5% vs 13.3%, respectively; P = 0.035). Anastomotic separation was identified in six (8.5%) patients and pelvic haematoma/seroma in five (7%); two (8.3%) female patients developed a recto–vaginal fistula. Ten (14.1%) patients were indefinitely diverted, with a trend towards higher long-term anastomotic failure in type 1 vs type 2 vs type 3 (17.6% vs 15.5% vs 6.7%). The type of anastomosis did not influence the overall or disease-free survival.ConclusionCAA is a safe technique in which anorectal continuity can be preserved either as a primary restorative option in elective cases of low rectal cancer or as a salvage procedure following a failed stapled anastomosis with a less successful outcome in the latter. CAA has acceptable morbidity with good long-term survival in carefully selected patients.
AU  - Tekkis,P
AU  - Tan,E
AU  - Kontovounisios,C
AU  - Kinross,J
AU  - Georgiou,C
AU  - Nicholls,RJ
AU  - Rasheed,S
AU  - Brown,G
DO  - 10.1111/codi.13028
EP  - 1070
PY  - 2015///
SN  - 1463-1318
SP  - 1062
TI  - Hand-sewn coloanal anastomosis for low rectal cancer: technique and long-term outcome
T2  - Colorectal Disease
UR  - http://dx.doi.org/10.1111/codi.13028
VL  - 17
ER  -

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