Comparison of short-term outcomes among hand-sewn, stapled, and two-stage Turnbull–Cutait pull-through anastomoses in TaTME for low rectal cancer

Q: What anastomotic techniques were compared in this TaTME study?

The study compared handsewn coloanal anastomosis (CAA), single-stapled anastomosis (SSA), and two-stage Turnbull–Cutait pull-through coloanal anastomosis (TCA).

Q: What was the primary endpoint of the study?

The primary endpoint was anastomosis-related complications, including anastomotic leakage, anastomotic bleeding, and anastomotic stricture.

Q: What key differences were observed among the three groups?

SSA had the shortest operative time, TCA had a lower protective stoma rate and longer postoperative hospital stay, and TCA showed longer resected bowel length with a higher incidence of neorectal prolapse.

Sep 23, 2026

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Transanal total mesorectal excision (TaTME) is a key surgical approach for low rectal cancer, yet the optimal anastomotic technique remains uncertain. This retrospective study evaluated short-term outcomes after TaTME in 147 patients with tumors distal to the anal verge within 5 cm. Patients received handsewn coloanal anastomosis (CAA), single-stapled anastomosis (SSA), or two-stage Turnbull–Cutait pull-through coloanal anastomosis (TCA).

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Introduction

Surgical challenges in low rectal cancer

Anastomotic techniques and existing evidence

Rationale for comparative analysis

Techniques in Coloproctology (2026) 30:88 [https://doi.org/10.1007/s10151-026-03348-y](https://doi.org/10.1007/s10151-026-03348-y) Comparison of short‑term outcomes among hand‑sewn, stapled, and two‑stage Turnbull–Cutait pull‑through anastomoses in TaTME for low rectal cancer Q. Guo1 · G. Chen2 · Q. Teng1 · W. Huang2 · L. Mao2 · D. Bai1 · Y. Xie1 · D. Zhou1 · M. Ren1 · Y. Tian1 Received: 6 June 2025 / Accepted: 16 April 2026 © The Author(s) 2026 Abstract Background Although transanal total mesorectal excision (TaTME) has been recognized as an important surgical method for low rectal cancer, optimal anastomotic techniques remain debated. This study compared short-term outcomes of handsewn coloanal anastomosis (CAA), single-stapled anastomosis (SSA), and two-stage Turnbull–Cutait pull-through coloanal anastomosis (TCA) . Methods A retrospective analysis of 147 patients who underwent TaTME for low rectal cancer (tumor distal margin ≤ 5 cm from anal verge) was conducted between July 2020 and July 2023. The patients were categorized into CAA, SSA, and TCA groups based on the anastomosis. The primary endpoint was anastomosis-related complications that included anastomotic leakage, anastomotic bleeding, and anastomotic stricture. The secondary endpoints included neorectal prolapse, pathological outcomes, perioperative outcomes, stoma-related outcomes, and functional outcomes assessed through the low anterior resection syndrome (LARS) scoring system. Results Among 147 patients with low rectal cancer, 42 patients underwent CAA, 69 patients underwent SSA, and 36 patients underwent TCA. Operative time was shortest in the SSA group and longest in the TCA group (p = 0.023) . TCA demonstrated a lower protective stoma rate (p = 0.005), higher splenic flexure mobilization (SFM) rate (p = 0.014), and extended postoperative hospital stay (p< 0.001) compared to CAA and SSA. Pathologically, TCA resulted in longer length of resected bowel (p < 0.001), with similar distal resection margins and lymph node yield. The complication rates were similar among the three groups, although the TCA group had a higher incidence of neorectal prolapse (p < 0.001) . LARS scores improved gradually in all groups postoperatively, with SSA potentially reducing its incidence. Conclusion In TaTME, SSA may reduce the incidence of LARS, whereas TCA avoids the need for a stoma at the expense of longer bowel resection and an increased risk of neorectal prolapse. Patient-specific selection of the anastomotic technique remains recommended. Keywords Transanal total mesorectal excision · Low rectal cancer · Anastomosis · Turnbull–Cutait pull-through · Complication Introduction Total mesorectal excision (TME) has become the standard surgical procedure for rectal cancer and has been effective in reducing local recurrence rates [1] . However, low rectal cancer remains challenging for surgeons as a result of limited surgical visibility and narrow operating spaces. Transanal total mesorectal excision (TaTME) was first introduced by Syllain 2010, providing an innovative surgical approach for low rectal cancers [2] . Compared with conventional laparoscopic techniques, the distinctive bottom-up approach in TaTME offers enhanced operative visualization in narrow pelvic anatomy, which may lead to higher negative circumferential resection margin (CRM) rates [3] . Anastomosis for low rectal cancer remains challenging because of anatomical constraints. Existing linear staplers have difficulty achieving a perpendicular rectal transection [4], and multiple firings of linear staplers are often required to complete rectal transection, which may increase the risk of anastomotic leakage [5]. Additionally, the intersection of staple lines (dog ear) obtained after the double-stapled anastomosis technique also increases the risk of anastomotic leakage [6] . Current evidence on different anastomotic techniques in TaTME remains limited. TaTME avoids the necessity of linear

FAQs

What anastomotic techniques were compared in this TaTME study?

The study compared handsewn coloanal anastomosis (CAA), single-stapled anastomosis (SSA), and two-stage Turnbull–Cutait pull-through coloanal anastomosis (TCA).

What was the primary endpoint of the study?

The primary endpoint was anastomosis-related complications, including anastomotic leakage, anastomotic bleeding, and anastomotic stricture.

What key differences were observed among the three groups?

SSA had the shortest operative time, TCA had a lower protective stoma rate and longer postoperative hospital stay, and TCA showed longer resected bowel length with a higher incidence of neorectal prolapse.

Sep 23, 2026

Uploaded by Aldword