Laparoscopic total mesorectal excision and delayed coloanal anastomosis without stoma for low rectal cancer: report of 50 consecutive cases: P098


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Abstract

Aim:It is routinepractice to create a defunctioning ileostomy after total mesorectal excision and anastomosis for low rectal cancer, to minimize the morbidity should a leak occur. However, the stoma is also associated with a risk of morbidity and cost. Delayed coloanal anastomosis is particularly suited to the laparoscopic approach and carries many potential advantages.Method:From February 2003 to June 2008, 50 consecutive patients of mean age 61 were operated on laparoscopically for a low rectal cancer and had a delayed coloanal anastomosis. No stoma was created. Technical and functional results wereprospectively studied at month 1, 6, and 12.Results:There was no deaths. Early complicationsoccured in eight patients: three anastomotic leaks, threepresacral abcesses, one anastomotic bleeding due to Vitamin K antagonist intake and one urinary retention. Late complications included mild anastomotic stenosis in five and colonicprolapse in one. The functional results at month 12 (assessed by number of bowel motions and Cleveland Clinic Score) was good or very good in 42 patients. Six menpresented with sexual dysfunction.Conclusion:Laparoscopic delayed coloanal anastomosis avoids the need for a stoma in 94% of cases and carries good technical and functional results in the majority of patients.

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