Cirugia espanola · 2026
Results of manual colo-anal anastomosis for lower rectal cancer. A multicenter cohort study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Trenti Loris, Merino David, Kreisler Esther, Gómez Marcos, Ortega Nuria, Serra Xavier, Millan Mónica, Cidoncha Ariadna, Navio Ana, Barrios Oriana, Lazzara Claudio, Farres Ramon, Flor Blas, Miguel Bernat, Biondo Sebastiano
Аннотация
INTRODUCTION: Manual colo-anal anastomosis (ACAm) is a technique used in patients with lower rectal cancer who are candidates for sphincter-preserving surgery when mechanical anastomosis is not feasible. Long-term outcomes, particularly regarding anastomotic failure and functional results, remain limited. This study analyzes the outcomes achieved with this technique.
METHODS: Retrospective multicenter study of a cohort of 155 patients with ACAm between 2009 and 2018. The study included 116 cases of conventional ACAm (CAAW) and 39 with two-stage technique (TCA). The primary objective was to analyze stoma-free survival. Secondary objectives included analysis of short-term and long-term complications, oncological, functional, and quality of life outcomes.
RESULTS: The median follow-up was 4.8 years. Postoperative morbidity at short- and long-term was 52.3% and 35.5%, respectively. Five-year stoma-free survival was 75.4%, with ACAm-related complications (HR 4.97; 95% CI: 2.04-12.09) and M1 status at diagnosis (HR 3.84; 95% CI: 1.56-9.43) identified as predictive factors for anastomotic failure and permanent stoma. Five-year overall survival and disease-free survival were 89.1% and 79.7%, respectively. Functional questionnaires showed that 19.1% (95% CI: 10.9-26.1) of patients had normal bowel function, 41.5% (95% CI: 33.4-53.2) had moderate function, and 38.3% (95% CI: 30.4-49.9) had poor function.
CONCLUSIONS: ACAm presents acceptable oncologic outcomes. Defecatory function is suboptimal in a significant proportion of patients, and one in four will require a stoma, highlighting the need for careful patient selection and individualized preoperative counseling.
METHODS: Retrospective multicenter study of a cohort of 155 patients with ACAm between 2009 and 2018. The study included 116 cases of conventional ACAm (CAAW) and 39 with two-stage technique (TCA). The primary objective was to analyze stoma-free survival. Secondary objectives included analysis of short-term and long-term complications, oncological, functional, and quality of life outcomes.
RESULTS: The median follow-up was 4.8 years. Postoperative morbidity at short- and long-term was 52.3% and 35.5%, respectively. Five-year stoma-free survival was 75.4%, with ACAm-related complications (HR 4.97; 95% CI: 2.04-12.09) and M1 status at diagnosis (HR 3.84; 95% CI: 1.56-9.43) identified as predictive factors for anastomotic failure and permanent stoma. Five-year overall survival and disease-free survival were 89.1% and 79.7%, respectively. Functional questionnaires showed that 19.1% (95% CI: 10.9-26.1) of patients had normal bowel function, 41.5% (95% CI: 33.4-53.2) had moderate function, and 38.3% (95% CI: 30.4-49.9) had poor function.
CONCLUSIONS: ACAm presents acceptable oncologic outcomes. Defecatory function is suboptimal in a significant proportion of patients, and one in four will require a stoma, highlighting the need for careful patient selection and individualized preoperative counseling.