Analysis of outcomes of intra-operative rectal washout in patients with rectal cancer during anterior resection

Abstract

Local recurrence is a major setback for patients with rectal cancer after surgery. Implantation of exfoliated malignant cells has been considered as a possible mechanism of tumor recurrence. Although still controversial, intra-operative rectal washout has been described as a method to remove exfoliated malignant cells and reduce recurrence rates. The current study was designed to assess the differences in outcomes of patients with or without rectal washout. Data of 144 patients with rectal cancer undergoing anterior resection between 2006 and 2007 were reviewed in our study. 69 patients received rectal washout with approximately 1,500 ml physiological saline before anastomosis, and 75 patients received no-washout. The washout samples were sent for cytological examination. The incidence of recurrence and 5-year disease-free survival rates of the two groups were compared. Three patients had local recurrence in the washout group compared with 5 patients with no-washout during a median follow-up of 48 months (p = 0.721). The 5-year disease-free survival rate was 79.7 and 74.7 % in washout and no-washout groups, respectively (p = 0.553). Our results demonstrated that exfoliated malignant cells were ubiquitous in the rectal lumen during anterior resection. The difference of prognosis was not statistically significant, though trended toward being improved in the washout group. A large-scale research with longer follow-up time is required to draw a significant conclusion.