• Maxime K Collard, Eric Rullier, Jean-Jacques Tuech, Charles Sabbagh, Amine Souadka, Jérome Loriau, Jean-Luc Faucheron, Stéphane Benoist, Anne Dubois, Frédéric Dumont, Adeline Germain, Gilles Manceau, Frédéric Marchal, Isabelle Sourrouille, Zaher Lakkis, Bernard Lelong, Simon Derieux, Guillaume Piessen, Anaïs Laforest, Aurélien Venara, Michel Prudhomme, Cécile Brigand, Emilie Duchalais, Mehdi Ouaissi, Gil Lebreton, Philippe Rouanet, Diane Mège, Karine Pautrat, Ian S Reynolds, Marc Pocard, Yann Parc, Quentin Denost, Jérémie H Lefevre, and GRECCAR group.
• Department of Colorectal Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne University, Paris, France.
• Ann. Surg. 2023 Nov 1; 278 (5): 781789781-789.

ObjectivesTo assess the specific results of delayed coloanal anastomosis (DCAA) in light of its 2 main indications.BackgroundDCAA can be proposed either immediately after a low anterior resection (primary DCAA) or after the failure of a primary pelvic surgery as a salvage procedure (salvage DCAA).MethodsAll patients who underwent DCAA intervention at 30 GRECCAR-affiliated hospitals between 2010 and 2021 were retrospectively included.ResultsFive hundred sixty-four patients (male: 63%; median age: 62 years; interquartile range: 53-69) underwent a DCAA: 66% for primary DCAA and 34% for salvage DCAA. Overall morbidity, major morbidity, and mortality were 57%, 30%, and 1.1%, respectively, without any significant differences between primary DCAA and salvage DCAA ( P = 0.933; P = 0.238, and P = 0.410, respectively). Anastomotic leakage was more frequent after salvage DCAA (23%) than after primary DCAA (15%), ( P = 0.016).Fifty-five patients (10%) developed necrosis of the intra-abdominal colon. In multivariate analysis, intra-abdominal colon necrosis was significantly associated with male sex [odds ratio (OR) = 2.67 95% CI: 1.22-6.49; P = 0.020], body mass index >25 (OR = 2.78 95% CI: 1.37-6.00; P = 0.006), and peripheral artery disease (OR = 4.68 95% CI: 1.12-19.1; P = 0.030). The occurrence of this complication was similar between primary DCAA (11%) and salvage DCAA (8%), ( P = 0.289).Preservation of bowel continuity was reached 3 years after DCAA in 74% of the cohort (primary DCAA: 77% vs salvage DCAA: 68%, P = 0.031). Among patients with a DCAA mannered without diverting stoma, 75% (301/403) have never required a stoma at the last follow-up.ConclusionsDCAA makes it possible to definitively avoid a stoma in 75% of patients when mannered initially without a stoma and to save bowel continuity in 68% of the patients in the setting of failure of primary pelvic surgery.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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