Abstract:

Aim: Anastomotic leak after sphincter-preserving surgery for rectal cancer may be a disaster scenario. To reduce the severity of anastomotic leakage a prophylactic diverting ileostomy is usually used for mid or distal rectal cancer patients. However, Turnbull Cutait Abdominoperineal Pull-Through Procedure (T-C) with low anastomotic leakage rates is an old method that is applied without diverting ileostomy. We aimed to evaluate the long-term functional and oncological results of the T-C procedure performed in patients with rectum cancer refusing diverting ileostomy. Method: Patients with middle or low rectal cancer who underwent T-C from March 2006 to December 2012 retrospectively reviewed for late results. Demographics, oncologic characteristics, postoperative complications, fuctional outcomes and overall survival (OS) time were evaluated. For functional results, Wexner Continence Grading scale scores, bladder functions, sexual functions, and SF-12 questionnaires were performed in all patients. In addition, anal manometry and defecography were performed in 7 patients. Results: Thirteen patients (6 men) median age 55 (range 44-82) years with rectal tumors at a median distance of 4 cm (range 1.5-7) from the anal verge underwent T-C. Mean follow-up was 101.2 (standard deviation 42.7) mounts. The 5-year OS rates was 85% . Postoperative morbidity rate is 23% (3 patients) . However, pelvic sepsis, anastomotic leak and perianal fistula were not seen. Functional results were good in 90% of patients at the end of the second year. Due to ongoing fragmentation and evacuation problems, 2 patients underwent permanent stoma. Conclusion: T-C with reasonable oncologic and functional results can be safely used sphincter-preserving procedure to treat patients with middle and distal rectal cancer without creation of diverting ileostomy.

Keywords: