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Rectal washout eliminates exfoliated malignant cells

D C Jenner¹, W B de Boer, G Clarke

¹Department of Colorectal Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia.

Diseases of the Colon and Rectum

|November 21, 1998

Summary

Rectal stump irrigation effectively eliminates malignant cells before colorectal anastomosis. This practice significantly reduces the presence of exfoliated cancer cells in the rectal vicinity, potentially impacting local recurrence rates in colorectal cancer surgery.

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Area of Science:

Colorectal Surgery
Surgical Oncology
Cytopathology

Background:

Rectal stump irrigation is a common practice in colorectal surgery for carcinoma.
Its effectiveness in eliminating exfoliated malignant cells and reducing local recurrence remains debated.
Surgical techniques vary regarding routine rectal stump irrigation.

Purpose of the Study:

To compare the efficacy of rectal stump irrigation in eliminating exfoliated malignant cells.
To evaluate the impact of a surgeon's routine practice of rectal irrigation versus non-irrigation.

Main Methods:

A comparative study involving two groups of ten patients each.
One group received rectal washout with normal saline via Foley catheter; the other did not.
Cytologic examination of saline used for washout and stapler rinsing, with cytopathologist blinded to group allocation.

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Main Results:

No malignant cells were detected in the rectal washout group (0/10).
Malignant cells were found in eight out of ten patients in the non-washout group (8/10).
A statistically significant difference was observed (P = 0.007).

Conclusions:

Rectal washout effectively eliminates exfoliated malignant cells in the rectal stump near the anastomosis.
This procedure demonstrates significant potential in reducing malignant cell presence during colorectal cancer surgery.