Low rectal cancer anastomosis: Techniques, indications and functional outcomes

Surgery for lower rectal cancer poses a significant challenge because avoiding a permanent colostomy requires technically complex low anastomosis. This article reviews the different anastomotic techniques following total mesorectal excision (TME), with particular emphasis on the Turnbull-Cutait (T-C) technique and transanal transection with single-stapled anastomosis (TTSS). The T-C technique enables a two-stage coloanal anastomosis without the need for a protective ileostomy, thereby reducing stoma-related morbidity. Meanwhile, TTSS improves precision in distal resection and reduces the incidence of anastomotic leakage. Appropriate patient selection is key to determining the most suitable surgical strategy. Despite technical advances, the incidence of low anterior resection syndrome remains high in this patient group. Surgical decisions should be individualized, taking into account each patient's profile and the anticipated oncological and functional outcomes.