Results of manual colo-anal anastomosis for lower rectal cancer. A multicenter cohort study

Manual colo-anal anastomosis (ACAm) is a technique used in patients with lower rectal cancer who are candidates for sphincter-preserving surgery when mechanical anastomosis is not feasible. Long-term outcomes, particularly regarding anastomotic failure and functional results, remain limited. This study analyzes the outcomes achieved with this technique.

Retrospective multicenter study of a cohort of 155 patients with ACAm between 2009 and 2018. The study included 116 cases of conventional ACAm (CAAW) and 39 with two-stage technique (TCA). The primary objective was to analyze stoma-free survival. Secondary objectives included analysis of short-term and long-term complications, oncological, functional, and quality of life outcomes.

The median follow-up was 4.8 years. Postoperative morbidity at short- and long-term was 52.3% and 35.5%, respectively. Five-year stoma-free survival was 75.4%, with ACAm-related complications (HR 4.97; 95% CI: 2.04-12.09) and M1 status at diagnosis (HR 3.84; 95% CI: 1.56-9.43) identified as predictive factors for anastomotic failure and permanent stoma. Five-year overall survival and disease-free survival were 89.1% and 79.7%, respectively. Functional questionnaires showed that 19.1% (95% CI: 10.9-26.1) of patients had normal bowel function, 41.5% (95% CI: 33.4-53.2) had moderate function, and 38.3% (95% CI: 30.4-49.9) had poor function.

ACAm presents acceptable oncologic outcomes. Defecatory function is suboptimal in a significant proportion of patients, and one in four will require a stoma, highlighting the need for careful patient selection and individualized preoperative counseling.