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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Is Delaying a Coloanal Anastomosis the Ideal Solution for Rectal Surgery?: Analysis of a Multicentric Cohort of 564 Patients from the GRECCAR
Annals of Surgery, Volume 278, No. 5, Year 2023
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Description
Objectives: To assess the specific results of delayed coloanal anastomosis (DCAA) in light of its 2 main indications. Background: DCAA can be proposed either immediately after a low anterior resection (primary DCAA) or after the failure of a primary pelvic surgery as a salvage procedure (salvage DCAA). Methods: All patients who underwent DCAA intervention at 30 GRECCAR-affiliated hospitals between 2010 and 2021 were retrospectively included. Results: Five hundred sixty-four patients (male: 63%; median age: 62 years; interquartile range: 53-69) underwent a DCAA: 66% for primary DCAA and 34% for salvage DCAA. Overall morbidity, major morbidity, and mortality were 57%, 30%, and 1.1%, respectively, without any significant differences between primary DCAA and salvage DCAA (P = 0.933; P = 0.238, and P = 0.410, respectively). Anastomotic leakage was more frequent after salvage DCAA (23%) than after primary DCAA (15%), (P = 0.016). Fifty-five patients (10%) developed necrosis of the intra-abdominal colon. In multivariate analysis, intra-abdominal colon necrosis was significantly associated with male sex [odds ratio (OR) = 2.67 95% CI: 1.22-6.49; P= 0.020], body mass index >25 (OR = 2.78 95% CI: 1.37-6.00; P = 0.006), and peripheral artery disease (OR = 4.68 95% CI: 1.12-19.1; P = 0.030). The occurrence of this complication was similar between primary DCAA (11%) and salvage DCAA (8%), (P = 0.289). Preservation of bowel continuity was reached 3 years after DCAA in 74% of the cohort (primary DCAA: 77% vs salvage DCAA: 68%, P = 0.031). Among patients with a DCAA mannered without diverting stoma, 75% (301/403) have never required a stoma at the last follow-up. Conclusions: DCAA makes it possible to definitively avoid a stoma in 75% of patients when mannered initially without a stoma and to save bowel continuity in 68% of the patients in the setting of failure of primary pelvic surgery. © 2023 Lippincott Williams and Wilkins. All rights reserved.
Authors & Co-Authors
Rullier, Éric
France, Bordeaux
Hopital Saint-andre
Souadka, Amine
Morocco, Agdal Rabat
National Institute of Oncology, Rabat
Dumont, Frédéric
France, Saint-herblain
Institut de Cancérologie de L'ouest
Manceau, Gilles
France, Paris
Hôpital Européen Georges-pompidou
Marchal, Fréd́eric
France, Nancy
Université de Lorraine
Sourrouille, Isabelle
Unknown Affiliation
Lakkis, Zaher
France, Besancon
Centre Hospitalier Universitaire de Besançon
Piessen, Guillaume
France, Lille
Chu Lille
Vénara, Aurélien
France, Angers
Chu Angers
Ouaïssi, Mehdi
France, Tours
Hopital Trousseau
Pocard, Marc
France, Paris
Hôpital Universitaire Pitié Salpêtrière
Denost, Quentin D.
Unknown Affiliation
Statistics
Authors: 12
Affiliations: 25
Identifiers
Doi:
10.1097/SLA.0000000000006025
ISSN:
00034932
Research Areas
Health System And Policy
Study Design
Randomised Control Trial
Cohort Study
Case-Control Study
Participants Gender
Male