title: Rectal washout eliminates exfoliated malignant cells.
abstract: OBJECTIVE
  Irrigation of the rectal stump before anastomosis after resection for carcinoma is accepted colorectal surgical practice. However, not all surgeons perform this routinely, and it has never been established conclusively that irrigation of the rectal stump eliminates exfoliated malignant cells or even reduces local recurrence. The patients of a surgeon whose standard surgical practice involved rectal irrigation were compared with those of a surgeon who does not routinely practice rectal irrigation.
  
  
  METHODS
  Ten patients were given rectal washout with 200 to 500 ml of normal saline introduced via a Foley catheter per rectum. Ten patients were not given rectal washout. In both groups the anastomosis was performed with a circular stapler, and the stapler and donuts were rinsed in 200 ml of normal saline. The saline was sent for cytologic examination and classified as malignant cells seen or no malignant cells seen. The cytopathologist was blinded to the washout status.
  
  
  RESULTS
  Of the ten patients who had rectal washout performed, none had malignant cells seen. Of the ten patients who did not have rectal washout performed, eight had malignant cells seen in the cytology (P = 0.007; two-tailed Fisher's exact probability test).
  
  
  CONCLUSIONS
  Rectal washout eliminates exfoliated malignant cells in the rectum in the vicinity of the anastomosis.
authors.affiliation: Department of Colorectal Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia.
authors.forename: D C
authors.initials: DC
authors.lastname: Jenner
authors.forename: W B
authors.initials: WB
authors.lastname: de Boer
authors.forename: G
authors.initials: G
authors.lastname: Clarke
authors.forename: M D
authors.initials: MD
authors.lastname: Levitt
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D007507:Therapeutic Irrigation; D016896:Treatment Outcome