Skip to main content

Advertisement

SpringerLink
Log in

Two-stage Turnbull-Cutait pull-through coloanal anastomosis versus coloanal anastomosis with protective loop ileostomy for low rectal cancer. Protocol for a randomized controlled trial (Turnbull-BCN)

  • Clinical Study Protocol
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to determine whether patients that underwent ultra-low rectal resection for cancer can benefit from the recently reintroduced two-stage Turnbull-Cutait abdominoperineal pull-through procedure.

Methods

Patients with low rectal tumors undergoing radical sphincter-sparing resection are eligible for inclusion in a randomized multicenter study. Whether two-stage Turnbull-Cutait coloanal anastomosis provides significant benefits over hand-sewn coloanal anastomosis and associated lateral ileostomy in terms of postoperative morbidity is the primary endpoint. In addition, the study aims to assess secondary endpoints such as quality of life, fecal incontinence, and locoregional recurrence of the neoplasm. Patients with adenocarcinoma of the lower rectum diagnosed by rigid proctoscopy, with histological confirmation of malignancy, and who are candidates of rectal removal and coloanal anastomosis will be included in a randomized controlled and multicenter trial. Postoperative morbidity is defined as complications that occur within 30 days of the data of the second surgical procedure of the last patient included in the trial. Patients will be followed for a minimum period of 3 years.

Conclusions

The two-stage Turnbull-Cutait coloanal anastomosis may constitute an effective surgical alternative in the current approach to the treatment of low rectal cancer without the need of a temporary loop colostomy, preventing the wide range of complications related to stoma surgery.

Trial registration

This trial is registered at clinicaltrials.gov (trial number: NCT01766661). This trial is registered in January 10, 2013.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Eriksen MT, Wibe A, Norstein J, Haffner J, Wiig JN (2005) Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Color Dis 7:51–57

    Article  CAS  Google Scholar 

  2. Bell SW, Walker KG, Rickard MJ, Sinclair G, Dent OF, Chapuis PH, Bokey EL (2003) Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence. Br J Surg 90:1261–1266

    Article  CAS  PubMed  Google Scholar 

  3. Matthiessen P, Hallböök O, Rutegård J, Simert G, Sjödahl R, Göran (2007) Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 246:207–214

    Article  PubMed  PubMed Central  Google Scholar 

  4. Gessler B, Haglind E, Angenete E (2012) Loop ileostomies in colorectal cancer patients-morbidity and risk factors for nonreversal. J Surg Res 178:708–714

    Article  PubMed  Google Scholar 

  5. Sharma A, Deeb AP, Rickles AS, Iannuzzi JC, Monson JR, Fleming SJ (2013) Closure of defunctioning loop ileostomy is associated with considerable morbidity. Color Dis 15:458–462

    Article  CAS  Google Scholar 

  6. Danielsen AK, Park J, Jansen JE, Bock D, Skullman S, Wedin A, Marinez AC, Haglind E, Angenete E, Rosenberg J (2017) Early closure of a temporary ileostomy in patients with rectal cancer: a multicenter randomized controlled trial. Ann Surg 265:284–290

    Article  PubMed  Google Scholar 

  7. Musters GD, Atema JJ, van Westreenen HL, Buskens CJ, Bemelman WA, Tanis PJ (2016) Ileostomy closure by colorectal surgeons results in less major morbidity: results from an institutional change in practice and awareness. Int J Color Dis 31:661–667

    Article  CAS  Google Scholar 

  8. Man VC, Choi HK, Law WL, Foo DC (2016) Morbidities after closure of ileostomy: analysis of risk factors. Int J Color Dis 31:51–57

    Article  Google Scholar 

  9. Biondo S, Frago R, Codina Cazador A, Farres R, Olivet F, Golda T, Miguel B, Kreisler E (2013) Long-term functional results from a randomized clinical study of transverse coloplasty compared with colon J-pouch after low anterior resection for rectal cancer. Surgery 153:383–392

    Article  PubMed  Google Scholar 

  10. Juul T, Ahlberg M, Biondo S, Espin E, Jimenez LM, Matzel KE, Palmer GJ, Sauermann A, Trenti L, Zhang W, Laurberg S, Christensen P (2014) Low anterior resection syndrome and quality of life: an international multicenter study. Dis Colon Rectum 57:585–591

    Article  PubMed  Google Scholar 

  11. Turnbull RB Jr, Cuthbertson A (1961) Abdominorectal pull-through resection for cancer and for Hirschsprung’s disease. Delayed posterior colorectal anastomosis. Cleve Clin Q 28:109–115

    Article  PubMed  Google Scholar 

  12. Cutait DE, Figliolini FJ (1961) A new method of colorectal anastomosis in abdominoperineal resection. Dis Colon Rectum 4:335–342

    Article  CAS  PubMed  Google Scholar 

  13. Knight CD, Griffen FD (1980) An improved technique for low anterior resection of the rectum using the EEA stapler. Surgery 88:710–714

    CAS  PubMed  Google Scholar 

  14. Parks AG (1972) Transanal technique in low rectal anastomosis. Proc R Soc Med 65:975–976

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Biondo S, Trenti L, Kreisler E (2014) Distal third rectal cancer: intersphincteric anterior resection with manual anastomosis using the techniques of Parks or Turnbull-Cutait. [Article in Spanish]. Cir Esp 92(Suppl 1):13–20

    Article  PubMed  Google Scholar 

  16. Baulieux J, Olagne E, Ducerf C, De La Roche E, Adham M, Berthoux N, Bourdeix O, Gérard JP (1999) Oncologic and functional results of resections with direct delayed coloanal anastomosis in previously irradiated cancers of the lower rectum. [Article in French]. Chirurgie 124:240–251

    Article  CAS  PubMed  Google Scholar 

  17. Remzi FH, El Gazzaz G, Kiran RP, Kirat HT, Fazio VW (2009) Outcomes following Turnbull-Cutait abdominoperineal pull-through compared with coloanal anastomosis. Br J Surg 96:424–429

    Article  CAS  PubMed  Google Scholar 

  18. Jarry J, Faucheron JL, Moreno W, Bellera CA, Evrard S (2011) Delayed colo-anal anastomosis is an alternative to prophylactic diverting stoma after total mesorectal excision for middle and low rectal carcinomas. Eur J Surg Oncol 37:127–133

    Article  CAS  PubMed  Google Scholar 

  19. Prete F, Prete FP (2013) The pull-through: back to the future. G Chir 34:293–301

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Biondo S, Trenti L, Espín E, Frago R, Vallribera F, Jiménez LM, Gálvez A, Sánchez JL, Kreisler E (2012) Post-surgical complications and mortality after two-stage coloanal anastomosis using the Turnbull-Cutait procedure. [Article in Spanish]. Cir Esp 90:248–253

    Article  PubMed  Google Scholar 

  21. Bianco F, Belli A, De Franciscis S, Falato A, Romano GM (2016) “Scarless” and no-stoma surgery for low rectal cancer: the laparoscopic pull-through delayed “high” colo-anal anastomosis. Updat Surg 68:99–104

    Article  Google Scholar 

  22. Fixot K, Galifet M, Scherrer ML, Germain A, Bresler L (2014) Abdominoperineal pull-through resection with delayed coloanal anastomosis as treatment option for complex recto-urinary fistulas. Int J Color Dis 29:407–409

    Article  Google Scholar 

  23. Xiong Y, Huang P, Ren QG (2016) Transanal pull-through procedure with delayed versus immediate coloanal anastomosis for anus-preserving curative resection of lower rectal cancer: a case-control study. Am Surg 82:533–539

    PubMed  Google Scholar 

  24. Patsouras D, Yassin NA, Phillips RK (2014) Clinical outcomes of colo-anal pull-through procedure for complex rectal conditions. Color Dis 16:253–258

    Article  CAS  Google Scholar 

  25. Hallet J, Milot H, Drolet S, Desrosiers E, Grégoire RC, Bouchard A (2014) The clinical results of the Turnbull-Cutait delayed coloanal anastomosis: a systematic review. Tech Coloproctol 18:579–590

    Article  CAS  PubMed  Google Scholar 

  26. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205-213.

  27. Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97

    Article  CAS  PubMed  Google Scholar 

  28. Juul T, Ahlberg M, Biondo S, Emmertsen KJ, Espin E, Jimenez LM, Matzel KE, Palmer G, Sauermann A, Trenti L, Zhang W, Laurberg S, Christensen P (2014) International validation of the low anterior resection syndrome score. Ann Surg 259:728–734

    Article  PubMed  Google Scholar 

  29. Bakx R, Sprangers MA, Oort FJ, van Tets WF, Bemelman WA, Slors JF, van Lanschot JJ (2005) Development and validation of a colorectal functional outcome questionnaire. Int J Colorectal Dis 20:126-136. 

  30. Glimelius B, Påhlman L, Cervantes A; ESMO Guidelines Working Group (2010) Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 21 Suppl 5:v82-86. 

  31. Biondo S, Ortiz H, Lujan J, Codina-Cazador A, Espin E, Garcia-Granero E, Kreisler E, de Miguel M, Alos R, Echeverria A (2010). Quality of mesorectum after laparoscopic resection for rectal cancer - results of an audited teaching programme in Spain. Colorectal Dis 12:24-31. 

Download references

Acknowledgements

We thank Marta Pulido, MD, for editing the manuscript and editorial assistance and Bernat Miguel for monitoring the study.

Author information

Authors and Affiliations

  1. Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, C/ Feixa Llarga s/n, L’Hospitalet de Llobregat, 08907, Barcelona, Spain

    Sebastiano Biondo, Loris Trenti, Ana Galvez & Esther Kreisler

  2. Department of General and Digestive Surgery, Colorectal Unit, Vall d’Hebron University Hospital, Autonomic University of Barcelona, Barcelona, Spain

    Eloy Espin-Basany

  3. Department of Abdominal Oncologic Surgery, National Cancer Institute “G. Pascale”, Naples, Italy

    Francesco Bianco & Giovanni Romano

Authors
  1. Sebastiano Biondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Loris Trenti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ana Galvez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eloy Espin-Basany
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francesco Bianco
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giovanni Romano
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Esther Kreisler
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

the Turnbull-BCN study group

  • Ana Blanco-Alvarez
  • , Cristina Quiñones-Sanchez
  • , Jose Jerez-Gonzalez
  • , Thomas Golda
  • , Ricardo Frago
  • , Domenico Fraccalvieri
  • , Jose L. Sanchez-Garcia
  •  & Silvia De Franciscis

Contributions

All authors contributed to the design and writing of the paper. All authors have read and approved the final manuscript.

Turnbull-BCN study group

Ana Blanco-Alvarez, Cristina Quiñones-Sanchez, and Jose Jerez-Gonzalez (Clinical colorectal nurses Bellvitge Hospital), Thomas Golda, Ricardo Frago, and Domenico Fraccalvieri (Colorectal surgeons Bellvitge Hospital), Jose L Sanchez-Garcia (Colorectal surgeon Vall d’Hebron Hospital), and Silvia De Franciscis (Digestive surgeon G. Pascale Hospital)

Corresponding author

Correspondence to Sebastiano Biondo.

Ethics declarations

Funding

The study is funded by Instituto Carlos III, Fondo de Investigación en Salud (FIS), (project PI15/00485), Ministry of Industry and Competitiveness, Government of Spain, and Fondo Europeo de Desarrollo Regional (FEDER). Granted by the Spanish Association of Coloproctology Foundation (FAECP)

Competing interests

The authors declare that they have no competing interests.

Ethics approval and consent to participate

The study has been approved by the local ethics committees of the participating centers.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Biondo, S., Trenti, L., Galvez, A. et al. Two-stage Turnbull-Cutait pull-through coloanal anastomosis versus coloanal anastomosis with protective loop ileostomy for low rectal cancer. Protocol for a randomized controlled trial (Turnbull-BCN). Int J Colorectal Dis 32, 1357–1362 (2017). https://doi.org/10.1007/s00384-017-2842-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-017-2842-4

Keywords

Search

Navigation