title: "Scarless" and no-stoma surgery for low rectal cancer: the laparoscopic pull-through delayed "high" colo-anal anastomosis.
abstract: Despite recent improvements in surgical technique, low rectal anastomoses for rectal cancer still carry a not negligible incidence of anastomotic leakage and pelvic related morbidity. The Turnball-Cutait delayed colo-anal anastomosis, also referred as pull-through procedure was introduced with the aim to reduce the surgical anastomotic related complications and overcome the need of diverting ileostomy creation. Recently, this technique regained popularity as a viable option not only as salvage procedure after anastomotic failure or in case of hostile pelvis but also as first choice option in case of low rectal cancer. We report our experience with a personal technique for delayed "high" colo-anal anastomosis and its combination with a minimally invasive approach in order to reduce surgical morbidity, avoid the need for stoma creation and minimize the impact of surgery. Between 2011 and 2015, eight consecutive patients were operated for low rectal cancer by the described technique by a minimally invasive approach. The procedure was successfully completed in all cases. Post-operative major morbidity and 60 days mortality were nihil. There was no need for stoma creation or service laparotomy resulting in a virtually "scarless" surgery. Mean cumulative hospital stay (combining the two stages of the procedure) was 7, 6 days (range 7-9). The proposed technique by combining the advantage of a minimally invasive approach to those of a delayed "high" colo-anal anastomoses can be considered a viable option for the surgical treatment of low rectal cancer.
authors.affiliation: Division of SurgicalOncology, Department of AbdominalOncology, "Istituto Nazionale Tumori Fondazione G. Pascale"-IRCCS, 80131, Naples, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bianco
authors.affiliation: Division of SurgicalOncology, Department of AbdominalOncology, "Istituto Nazionale Tumori Fondazione G. Pascale"-IRCCS, 80131, Naples, Italy. a.belli@istitutotumori.na.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Belli
authors.affiliation: Division of SurgicalOncology, Department of AbdominalOncology, "Istituto Nazionale Tumori Fondazione G. Pascale"-IRCCS, 80131, Naples, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: De Franciscis
authors.affiliation: Division of SurgicalOncology, Department of AbdominalOncology, "Istituto Nazionale Tumori Fondazione G. Pascale"-IRCCS, 80131, Naples, Italy.
authors.forename: Armando
authors.initials: A
authors.lastname: Falato
authors.affiliation: Division of SurgicalOncology, Department of AbdominalOncology, "Istituto Nazionale Tumori Fondazione G. Pascale"-IRCCS, 80131, Naples, Italy.
authors.forename: Giovanni Maria
authors.initials: GM
authors.lastname: Romano
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D003106:Colon / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome
keywords: Coloanal; Ileostomy; Laparoscopy; Pull-through; Rectal cancer; Turnball-Cutait