Conducting stoma-free intersphincteric resection for ultra-low rectal cancers by selective delayed coloanal anastomosis, a single center experience.

Abstract

e15622 Background: Intersphincteric resection (ISR) is aimed at preserving the anus in patients with ultra-low rectal cancers (uLRCs). Previous reports show anastomotic leakage (AL) rates after ISR are 8.4%-17.0% in patients undergoing immediate coloanal anastomosis (ICAA) and 3.0%-8.6% for delayed coloanal anastomosis (DCAA). Protective stoma is routinely performed for ISR in most centers, which means extra incision, a second operation, additional risk of ostomy hernia, and high-Output Stoma. The current study aims to evaluate the safety and feasibility of stoma-free ISR. Methods: We retrospectively reviewed uLRC patients who underwent laparoscopic stoma-free-ISR (La-sf-ISR) between March 2023 and March 2024 at Colorectal Cancer Center, West China Hospital, Sichuan University. Decision of ICAA or DCAA was made depending on patient features and intraoperative judgement. Complications and postoperative anal function were estimated, and primary outcome is Clavien-Dindo grade IIIb-IV (C-D IIIb-IV) complication. Results: A total of 166 uLRC patients underwent La-sf-ISR were included (90 DCAAs and 76 ICAAs). The median tumor distances to annal verge were 4.6 cm vs 4.2 cm in DCAA and ICAA (p = 0.117). The median follow-up time for DCAA and ICAA were 13 months and 14 months. The incidence of C-D IIIb-IV complications (11.1% vs. 13.1%, p = 0.671), overall complications (44.4% vs. 34.2%, P = 0.237), long-term complications (17.8% vs. 19.7%, p = 0.902), and reoperation rates (13.3% vs. 17.1%, P = 0.646) were comparable between DCAA and ICAA groups. The incidence of short-term complication was higher in DCAA group (30% vs. 15.8%, p = 0.049). In the DCAA, 9/90 (10%) patients experienced AL, 4/90 (4.4%) of whom created a stoma. In the ICAA, 9/76 (11.8%) patients had AL, 6/76 (7.9%) of whom needed a stoma. Notably, 2/90 (2.2%) patients in DCAA needed repeatedly anal trimming, and 3/76 (3.9%) patients in ICAA group needed anal trimming because of neorectal mucosal prolapse. The LARS score, major LARS rate, and the Wexner score were comparable between two groups (30 (20-39) vs. 28.5 (16.8-34.0) p = 0.114; 53% vs. 43% p = 0.27; 10 (7-13) vs. 9 (6-12) P = 0.258). Conclusions: With selective use of DCAA or ICAA, La-sf-ISR shows acceptable safety, and functional outcome, indicating its feasibility. Follow-up, complication, and stoma status. DCAA N=90 ICAA N=76 p.overall Time of follow-up 13.0 [12.0;15.8] 14.0 [13.0;15.0] Overall complication 40 (44.4%) 26 (34.2%) Short-term complication 27 (30.0%) 12 (15.8%) 0.049 Reoperation 12 (13.3%) 13 (17.1%) Clavien-Dindo III-IV comlication 10（11.1%） 10（13.1%） LARS 30.0 [22.0;39.0] 28.5 [16.8;34.0] Major LARS 40(53%) 24(43%) Wexner 10.0 [7.00;13.0] 9.00 [6.00;12.0] History of stoma creation 7 （7.8%） 9 (11.8%) Bearing a stoma 4 (4.5%) 7 (9.2%)