title: Delayed colo-anal anastomosis is an alternative to prophylactic diverting stoma after total mesorectal excision for middle and low rectal carcinomas.
abstract: BACKGROUND
  After total mesorectal excision (TME), a low colorectal or colo-anal anastomosis is usually performed. A prophylactic covering stoma is often used, especially for patients receiving neoadjuvant chemo-radiotherapy. However, morbidity is high, mainly due to anastomotic leakage.
  
  
  METHODS
  From May 2000 to October 2008, patients with middle or low rectal cancer who underwent a trans-anal pull-through procedure after TME were prospectively recorded. No covering stoma was performed in these patients. However, they all underwent a delayed colo-anal anastomosis (DCA), which was performed 6 days following the TME, on average. Both the surgical technique and follow-up were standardised. Patients with T3, T4 and/or N+ cancers were given preoperative radiotherapy. A retrospective analysis was done to assess post-operative mortality, morbidity, and oncologic and functional results.
  
  
  RESULTS
  One hundred consecutive patients with rectal tumours at a median distance of 5 cm from the anal verge underwent DCA after TME. The 5-year overall and disease-free survival rates were 81% and 66%, respectively. The post-operative mortality rate was 3% and the overall post-operative morbidity rate was 36%, with only 3 anastomotic leakages. After two years, 73% of the patients had good functional outcomes.
  
  
  CONCLUSIONS
  The trans-anal pull-through procedure after TME, followed by DCA seems to be a safe and efficient sphincter-preserving procedure to treat patients with middle or low rectal cancer while avoiding a prophylactic, diverting stoma.
authors.affiliation: Institut Bergonié, Université de Bordeaux, Institut Bergonié Unit, 229 cours de l'Argonne, 33076 Bordeaux Cedex, France.
authors.forename: J
authors.initials: J
authors.lastname: Jarry
authors.forename: J L
authors.initials: JL
authors.lastname: Faucheron
authors.forename: W
authors.initials: W
authors.lastname: Moreno
authors.forename: C A
authors.initials: CA
authors.lastname: Bellera
authors.forename: S
authors.initials: S
authors.lastname: Evrard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D054047:Surgical Stomas