Our Summary

This paper discusses different techniques used in surgery for lower rectal cancer. The goal of these surgeries is to avoid a permanent colostomy, a procedure that creates an opening (stoma) for waste to leave the body, which can impact quality of life. Two techniques are highlighted: the Turnbull-Cutait (T-C) technique and transanal transection with single-stapled anastomosis (TTSS).

The T-C technique involves a two-step process that connects the colon and the anus (coloanal anastomosis) without needing a temporary stoma, reducing complications related to this. The TTSS technique improves the precision of the removal of the tumor and reduces the risk of leakage at the connection site (anastomotic leakage).

Choosing the right technique depends on the individual patient’s situation and the expected outcomes in terms of cancer control and bodily function. Even with these technological advancements, a large number of patients still experience complications after surgery for lower rectal cancer. Therefore, decisions regarding surgery should be made on a case-by-case basis, considering each patient’s unique circumstances.

FAQs

  1. What is the Turnbull-Cutait technique and how does it benefit patients with lower rectal cancer?
  2. How does the transanal transection with single-stapled anastomosis technique reduce the incidence of anastomotic leakage?
  3. How can appropriate patient selection influence the surgical strategy for lower rectal cancer?

Doctor’s Tip

One helpful tip a doctor might tell a patient about proctectomy is to discuss the different anastomotic techniques available, such as the Turnbull-Cutait (T-C) technique and transanal transection with single-stapled anastomosis (TTSS). Each technique has its own benefits and considerations, so it’s important to have a thorough discussion with your surgeon about which option may be best for your individual case. Additionally, it’s important to be aware of potential complications such as low anterior resection syndrome and to discuss with your doctor how to manage and minimize these risks.

Suitable For

Patients who are typically recommended for proctectomy include those with lower rectal cancer who are candidates for total mesorectal excision (TME) surgery. In particular, patients who require a low anastomosis to avoid a permanent colostomy may be recommended for proctectomy. Appropriate patient selection is crucial in determining the most suitable surgical strategy, and factors such as tumor stage, location, and overall health status will be taken into consideration. Patients with distal rectal cancer may also be recommended for proctectomy, as well as those who may benefit from the Turnbull-Cutait (T-C) technique or transanal transection with single-stapled anastomosis (TTSS) to reduce stoma-related morbidity or improve precision in distal resection.

Timeline

Before proctectomy:

  • Patient is diagnosed with lower rectal cancer and undergoes pre-operative evaluations such as imaging studies and blood tests.
  • Patient may undergo neoadjuvant therapy such as chemotherapy and/or radiation to shrink the tumor before surgery.
  • Patient discusses surgical options with their healthcare team, including the possibility of a permanent colostomy.
  • Patient undergoes proctectomy surgery, which involves removal of the rectum and possibly part of the colon.

After proctectomy:

  • Patient may stay in the hospital for several days to recover from the surgery.
  • Patient may have a temporary colostomy or ileostomy to allow the bowel to heal.
  • Patient may experience pain, fatigue, and changes in bowel function following surgery.
  • Patient may undergo adjuvant therapy such as chemotherapy to further treat the cancer.
  • Patient will have regular follow-up appointments with their healthcare team to monitor for any signs of recurrence and to address any long-term side effects of the surgery.

What to Ask Your Doctor

  1. What are the different types of anastomotic techniques available for proctectomy following total mesorectal excision (TME)?
  2. What are the benefits and risks associated with each type of anastomotic technique?
  3. How will the choice of anastomotic technique impact my recovery and quality of life post-surgery?
  4. What is the likelihood of experiencing anastomotic leakage or other complications with each type of technique?
  5. Can you explain the Turnbull-Cutait (T-C) technique and how it differs from other anastomotic techniques?
  6. How does the transanal transection with single-stapled anastomosis (TTSS) technique improve precision in distal resection compared to other techniques?
  7. Will I require a protective ileostomy with the Turnbull-Cutait technique or any other technique?
  8. What is the likelihood of developing low anterior resection syndrome following proctectomy, and how can it be managed?
  9. How will you determine which surgical strategy is most suitable for my individual case?
  10. What are the anticipated oncological and functional outcomes following proctectomy with the chosen anastomotic technique?

Reference

Authors: Gálvez A, Foppa C, Spinelli A, Biondo S. Journal: Cir Esp (Engl Ed). 2025 Jul;103(7):800129. doi: 10.1016/j.cireng.2025.800129. Epub 2025 Jun 5. PMID: 40482966