Abstract：
Surgery and management of rectal cancer have made significant progress in recent decades. However, there is still no coloanal anastomosis technique that offers a good compromise between functionality and low morbidity. The aim of this study is to evaluate the safety and efficiency of the modified delayed coloanal anastomosis (mDCA). In this retrospective study, we analyzed the morbi-mortality as well as functional outcomes of 19 patients treated with mDCA, out of 73 colorectal cancer patients treated at our institution from September 2021 to June 2023. The inclusion criteria were cancer of the mid and low rectum (tumor less than 10 cm from the anal verge). Morbidity represented by complications of Clavien-Dindo grade III or higher was estimated at 5.2%. Only one patient experienced an asymptomatic anastomotic leak (AL) grade A. Ischemia of the colonic stump occurred in one patient, taken back to the OR on the 5th postoperative day. No stump retraction was noted. Anastomotic stenosis appeared in one patient (5.2%) during the 90-day postoperative period, and was treated by instrumental dilation. Perioperative mortality was nil. The mean St Marks incontinence score at 90 days was 13.2 points. At the 3-month follow-up, 15 patients (78.9%) had major low anterior resection syndrome (LARS), three (15.7%) had minor LARS, and one patient (5.2%) had no LARS. None of the patients had a diversion loop ileostomy. The mDCA, by decreasing the rate of AL, without the need for diversion ileostomy, might be an interesting alternative to the conventional immediate coloanal anastomosis (ICA), for restoring the GI tract after proctectomy for cancer.
摘要：
近几十年来，直肠癌的手术和治疗取得了重大进展。然而,仍然没有结肠吻合术技术在功能性和低发病率之间提供良好的折衷。本研究的目的是评估改良延迟结肠吻合术（mDCA）的安全性和有效性。在这项回顾性研究中,我们分析了19例接受mDCA治疗的患者的死亡率和功能结局，2021年9月至2023年6月在我们机构接受治疗的73例结直肠癌患者中。纳入标准是中直肠和低位直肠癌（距肛门边缘小于10厘米的肿瘤）。Clavien-DindoIII级或更高的并发症所代表的发病率估计为5.2％。只有一名患者出现无症状的吻合口漏（AL）A级。一名患者发生结肠残端缺血，在术后第5天回到OR。没有注意到树桩缩回。1例患者（5.2%）在术后90天出现吻合口狭窄，并接受了器械扩张治疗。围手术期死亡率为零。90天的平均StMarks失禁评分为13.2分。在3个月的随访中，15例患者（78.9%）有主要的低位前切除综合征（LARS），三人(15.7%)有轻微的LARS，1例患者(5.2%)无LARS.没有患者进行分流回肠造口术。mDCA,通过降低AL的速率，不需要分流回肠造口术，可能是传统的即时结肠吻合术（ICA）的有趣替代方法，用于癌症直肠切除术后恢复胃肠道。
