Does rectal washout during anterior resection prevent local tumor recurrence?

Colorectal cancer is one of the leading causes of cancer deaths in the industrialized nations. Left-sided tumors, especially rectal, rectosigmoid, and sigmoid, account for more than half of these tumors. Among many colorectal surgeons, the practice of rectal washout with cytocidal agents before anastomosis is common. It is widely believed that this practice prevents implantation of free malignant cells. It is unclear whether this translates into a reduction in the incidence of local recurrence. This study was designed to evaluate the effectiveness of cytocidal rectal washout in reducing the incidence of local recurrence.

Case notes and histology reports of all patients who underwent curative anterior resection for adenocarcinoma of the rectum and rectosigmoid between 1992 and 1994 were reviewed. A total of 141 patients were deemed suitable for the study. Of these, 90 patients underwent rectal washout using cetrimide before anastomosis. Fifty-one patients did not have rectal washout before anastomosis. Local recurrences between the two groups were compared.

The two study groups were identical in all respects. Overall, the local recurrence rate for all comers was 5 percent (n = 7). Among the washout group, the local recurrence rate was 4.4 percent (n = 4) compared with 5.9 percent (n = 3) among the no washout group.

Because of the size of the study, we were unable to demonstrate the benefit or lack thereof of cytocidal agents in reducing local recurrence.