Evaluation of Delayed Coloanal Anastomosis

Study Overview
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Brief Summary
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After rectal resection for cancer of the lower rectum, the restoration of continuity is done by a colo-anal anastomosis with a protective ileostomy. However, the ileostomy is very little accepted by patients. It is associated with significant morbidity and a deterioration in the quality of life. Delayed colo-anal anastomosis has been proposed as an alternative to direct colo-anal anastomosis with a protective ileostomy. The theoretical advantage of this technique is to reduce the risk of anastomotic leaks and to avoid ileostomy. In this study, the investigators will retrospectively evaluate the short and midterm results of this technique.

Detailed Description
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After rectal resection for cancer of the lower rectum, the restoration of continuity is done by a colo-anal anastomosis with a protective ileostomy. The latter reduces the risk and severity of clinical anastomotic fistulas. However, the ileostomy is very little accepted by patients. It is associated with significant morbidity reaching up to 30% of patients, a deterioration in the quality of life and the need for a second surgery to restore digestive continuity. And specifically in low-income countries, ostomy bags are expensive and are not reimbursed, and therefore constitute a heavy burden for Moroccan patients. In order to overcome these drawbacks, delayed colo-anal anastomosis has been proposed as an alternative to direct colo-anal anastomosis with a protective ileostomy. This technique consists of externalizing the colon in the first stage by the transanal route, without creating an ileostomy, and waiting a week for the creation of the anastomosis. The theoretical advantage of this technique is to reduce the risk of anastomotic leaks and to avoid ileostomy. Several studies have shown encouraging results in the short and midterm, and it is listed among the technical options in the French recommendations for the management of rectal cancer. In this study, the investigators will retrospectively evaluate the short and midterm results of this technique.

Official Title
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Short and Midterm Results of Delayed Colo-anal Anastomosis After Rectal Resection

Conditions
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Rectal Neoplasms

Intervention / Treatment
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* Procedure: Delayed colo-anal anastomosis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients> 18 years old. Rectal resection with the creation of a delayed colo-anal anastomosis. Exclusion Criteria: None

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: Delayed colo-anal anastomosis|Colo-anal anastomosis performed in two surgical steps: - Step one: the colon is exteriorized transanally and 5 cm of the colon is left outside without anastomosis creation. Step two: after 7 days, the excess colon is resected and the colo-anal anastomosis is created.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Stoma rate at 90 days | The rate of patients who required a stoma creation at 90 days | 90 days | 
| Perineal complications | Rates of perineal complications at 90 days after surgery | 90 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clavien-Dindo complications | Rate of complications according to Clavien-Dindo grading | 90 days | 
| Functional outcomes | Continence score according to the Low anterior resection syndrom score (LARS). Score from 0 to 42 (0-20 No LARS / 21-29 Minor LARS / 30-42 Major LARS). Higher score indicates worse outcome | 12 months | 
| Quality of life assessement: EORTC QLQ30 score | Quality of life using the EORTC QLQ30 score at 6 and 12 months | 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Rectal neoplasmdelayed coloanal anastomosis, Ileostomy, Delayed coloanal anastomosis