{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T00:53:03Z","timestamp":1793321583009,"version":"4.5.0"},"reference-count":25,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2024,9,1]]},"abstract":"IMPORTANCE<\/jats:title>In patients operated on for low rectal cancer, 2-stage Turnbull-Cutait pull-through hand-sewn coloanal anastomosis provides benefits in terms of postoperative morbidity compared with standard hand-sewn coloanal anastomosis associated with diverting ileostomy and further ileostomy reversal.<\/jats:p><\/jats:sec>OBJECTIVE<\/jats:title>To compare long-term results of these 2 techniques after ultralow rectal resection for rectal cancer.<\/jats:p><\/jats:sec>DESIGN, Setting, and Participants<\/jats:title>In this randomized multicenter clinical trial, neither patients nor surgeons were blinded for technique. Patients were recruited in 3 centers. Patients undergoing ultralow anterior rectal resection needing hand-sewn coloanal anastomosis were randomly assigned to 2-stage Turnbull-Cutait pull-through hand-sewn coloanal anastomosis (n\u2009=\u200946) or standard hand-sewn coloanal anastomosis associated with diverting ileostomy (n\u2009=\u200946).<\/jats:p><\/jats:sec>INTERVENTIONS<\/jats:title>All patients underwent ultralow anterior resection. Patients assigned to the 2-stage Turnbull-Cutait pull-through group underwent exteriorization of a segment of left colon through the anal canal. After 6 to 10 days, the exteriorized colon was resected and a delayed hand-sewn coloanal anastomosis performed. For patients assigned to standard coloanal anastomosis, the hand-sewn coloanal anastomosis was performed with diverting ileostomy during the first operation. Ileostomy closure was scheduled after adjuvant treatment was completed in about 6 to 8 months.<\/jats:p><\/jats:sec>MAIN OUTCOME AND MEASURE<\/jats:title>The study aimed to compare the differences between the 2 groups in terms of long-term surgery-related morbidity, functional, and oncological outcomes at 3 years postoperatively. Data were analyzed from October 1, 2018, through October 31, 2021.<\/jats:p><\/jats:sec>RESULTS<\/jats:title>The 92 patients randomized in the first study were included for the 3-year follow-up. The overall morbidity rate in the 2 groups showed that 15 patients (16.3%) had complications with a difference of 6.52 (95% CI, \u22128.93 to 21.79). Nine patients (19.6%) and 6 patients (13.0%) in the 2-stage Turnbull-Cutait pull-through group and hand-sewn coloanal anastomosis group, respectively, had complications without statistically significant differences (P<\/jats:italic>\u2009=\u2009.57). Oncological results were comparable between the groups. Long-term fecal continence in the CCA and TCA groups, respectively, assessed using the Wexner Incontinence Score was 10.9 (5.50-15.5) vs 13.0 (7.25-16.0; P<\/jats:italic>\u2009=\u2009.92), Low Anterior Resection Syndrome score was 32.0 (21.0-37.0) vs 34.0 (23.2-38.5; P<\/jats:italic>\u2009=\u2009.76), and Colorectal Functional Outcome score was 38.5 (23.0-47.1) vs 40.8 (23.3-58.2; P<\/jats:italic>\u2009=\u2009.30).<\/jats:p><\/jats:sec>CONCLUSIONS AND RELEVANCE<\/jats:title>In this study, after a 3-year follow-up period, 2-stage Turnbull-Cutait anastomosis for ultralow rectal cancer could be considered as a surgical alternative that has the valuable benefit of avoiding a temporary stoma with similar results in terms of morbidity, fecal continence, patient satisfaction, quality of life, and oncological outcomes when compared with hand-sewn coloanal anastomosis with ileostomy.<\/jats:p><\/jats:sec>TRIAL REGISTRATION<\/jats:title>ClinicalTrials.gov Identifier: NCT01766661<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamasurg.2024.2262","type":"journal-article","created":{"date-parts":[[2024,7,10]],"date-time":"2024-07-10T15:02:20Z","timestamp":1720623740000},"page":"990","source":"Crossref","is-referenced-by-count":26,"title":["Long-Term Results of 2-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Low Rectal Cancer"],"prefix":"10.1001","volume":"159","author":[{"given":"Sebastiano","family":"Biondo","sequence":"first","affiliation":[{"name":"Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oriana","family":"Barrios","sequence":"additional","affiliation":[{"name":"Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loris","family":"Trenti","sequence":"additional","affiliation":[{"name":"Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eloy","family":"Espin","sequence":"additional","affiliation":[{"name":"Department of General and Digestive Surgery, Colorectal Unit, Vall d\u2019Hebron University Hospital, Autonomic University of Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Bianco","sequence":"additional","affiliation":[{"name":"General and Colorectal Surgery Unit, S. Leonardo Hospital\/ASL-Napoli 3-Sud, Castellammare di Stabia, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armando","family":"Falato","sequence":"additional","affiliation":[{"name":"General Surgery Unit, S. Giuliano Hospital, Giugliano, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"De Franciscis","sequence":"additional","affiliation":[{"name":"Colorectal Cancer Surgery Unit, Istituto Nazionale Tumori di Napoli, IRCCS, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Solis","sequence":"additional","affiliation":[{"name":"Department of General and Digestive Surgery, Colorectal Unit, Vall d\u2019Hebron University Hospital, Autonomic University of Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Kreisler","sequence":"additional","affiliation":[{"name":"Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"TURNBULL-BCN Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Blanco","sequence":"additional","affiliation":[{"name":"for the TURNBULL-BCN Study Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Golda","sequence":"additional","affiliation":[{"name":"for the TURNBULL-BCN Study Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Frago","sequence":"additional","affiliation":[{"name":"for the TURNBULL-BCN Study Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Fraccalvieri","sequence":"additional","affiliation":[{"name":"for the TURNBULL-BCN Study Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Galvez","sequence":"additional","affiliation":[{"name":"for the TURNBULL-BCN Study Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mireia","family":"Verdaguer","sequence":"additional","affiliation":[{"name":"for the TURNBULL-BCN Study Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piero A","family":"Alberti","sequence":"additional","affiliation":[{"name":"for the TURNBULL-BCN Study Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernat","family":"Miguel","sequence":"additional","affiliation":[{"name":"for the TURNBULL-BCN Study Group"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"5","key":"soi240045r1","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1097\/DCR.0b013e31827c4a8c","article-title":"Low rectal cancer: classification and standardization of surgery.","volume":"56","author":"Rullier","year":"2013","journal-title":"Dis Colon Rectum"},{"issue":"1","key":"soi240045r2","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1111\/j.1463-1318.2004.00700.x","article-title":"Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients.","volume":"7","author":"Eriksen","year":"2005","journal-title":"Colorectal Dis"},{"issue":"10","key":"soi240045r3","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1002\/bjs.4219","article-title":"Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence.","volume":"90","author":"Bell","year":"2003","journal-title":"Br J Surg"},{"issue":"2","key":"soi240045r4","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1097\/SLA.0b013e3180603024","article-title":"Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial.","volume":"246","author":"Matthiessen","year":"2007","journal-title":"Ann Surg"},{"issue":"29","key":"soi240045r5","doi-asserted-by":"publisher","first-page":"20816","DOI":"10.18632\/oncotarget.25015","article-title":"Defunctioning ileostomy reduces leakage rate in rectal cancer surgery\u2014systematic review and meta-analysis.","volume":"9","author":"Pisarska","year":"2018","journal-title":"Oncotarget"},{"issue":"3","key":"soi240045r6","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1097\/01.sla.0000154551.06768.e1","article-title":"Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule.","volume":"241","author":"Rullier","year":"2005","journal-title":"Ann Surg"},{"issue":"8","key":"soi240045r7","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2020.1625","article-title":"Two-stage Turnbull-Cutait pull-through coloanal anastomosis for low rectal cancer: a randomized clinical trial.","volume":"155","author":"Biondo","year":"2020","journal-title":"JAMA Surg"},{"issue":"9","key":"soi240045r8","doi-asserted-by":"publisher","first-page":"1357","DOI":"10.1007\/s00384-017-2842-4","article-title":"Two-stage Turnbull-Cutait pull-through coloanal anastomosis versus coloanal anastomosis with protective loop ileostomy for low rectal cancer. Protocol for a randomized controlled trial (Turnbull-BCN).","volume":"32","author":"Biondo","year":"2017","journal-title":"Int J Colorectal Dis"},{"issue":"1","key":"soi240045r9","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1007\/BF02050307","article-title":"Etiology and management of fecal incontinence.","volume":"36","author":"Jorge","year":"1993","journal-title":"Dis Colon Rectum"},{"issue":"5","key":"soi240045r10","doi-asserted-by":"publisher","first-page":"922","DOI":"10.1097\/SLA.0b013e31824f1c21","article-title":"Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer.","volume":"255","author":"Emmertsen","year":"2012","journal-title":"Ann Surg"},{"issue":"4","key":"soi240045r11","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1097\/SLA.0b013e31828fac0b","article-title":"International validation of the low anterior resection syndrome score.","volume":"259","author":"Juul","year":"2014","journal-title":"Ann Surg"},{"issue":"2","key":"soi240045r12","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1007\/s00384-004-0638-9","article-title":"Development and validation of a colorectal functional outcome questionnaire.","volume":"20","author":"Bakx","year":"2005","journal-title":"Int J Colorectal Dis"},{"issue":"1","key":"soi240045r13","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1007\/s00384-015-2327-2","article-title":"Morbidities after closure of ileostomy: analysis of risk factors.","volume":"31","author":"Man","year":"2016","journal-title":"Int J Colorectal Dis"},{"issue":"4","key":"soi240045r14","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1002\/bjs.6458","article-title":"Outcomes following Turnbull-Cutait abdominoperineal pull-through compared with coloanal anastomosis.","volume":"96","author":"Remzi","year":"2009","journal-title":"Br J Surg"},{"issue":"4","key":"soi240045r15","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1016\/j.ciresp.2011.12.006","article-title":"[Post-surgical complications and mortality after two-stage coloanal anastomosis using the Turnbull-Cutait procedure].","volume":"90","author":"Biondo","year":"2012","journal-title":"Cir Esp"},{"issue":"2","key":"soi240045r16","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1016\/j.ejso.2010.12.008","article-title":"Delayed colo-anal anastomosis is an alternative to prophylactic diverting stoma after total mesorectal excision for middle and low rectal carcinomas.","volume":"37","author":"Jarry","year":"2011","journal-title":"Eur J Surg Oncol"},{"issue":"1","key":"soi240045r17","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1007\/s10151-021-02538-0","article-title":"Prognostic factors for complications after loop ileostomy reversal.","volume":"26","author":"Climent","year":"2022","journal-title":"Tech Coloproctol"},{"key":"soi240045r18","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/S0009-739X(14)70004-1","article-title":"Distal third rectal cancer: intersphincteric anterior resection with manual anastomosis using the techniques of Parks or Turnbull-Cutait.","volume":"92","author":"Biondo","year":"2014","journal-title":"Cir Esp"},{"issue":"9","key":"soi240045r19","doi-asserted-by":"publisher","first-page":"1120","DOI":"10.1002\/bjs.11287","article-title":"Norwegian moratorium on transanal total mesorectal excision.","volume":"106","author":"Larsen","year":"2019","journal-title":"Br J Surg"},{"key":"soi240045r20","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1111\/codi.14376","article-title":"An international multicentre prospective audit of elective rectal cancer surgery; operative approach versus outcome, including transanal total mesorectal excision (TaTME).","volume":"20","author":"2017 European Society of Coloproctology (ESCP) collaborating group","year":"2018","journal-title":"Colorectal Dis"},{"issue":"9","key":"soi240045r21","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1002\/bjs.11525","article-title":"Locoregional recurrences after transanal total mesorectal excision of rectal cancer during implementation.","volume":"107","author":"van Oostendorp","year":"2020","journal-title":"Br J Surg"},{"issue":"1","key":"soi240045r22","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2021.5445","article-title":"Chemoradiotherapy plus induction or consolidation chemotherapy as total neoadjuvant therapy for patients with locally advanced rectal cancer: long-term results of the CAO\/ARO\/AIO-12 randomized clinical trial.","volume":"8","author":"Fokas","year":"2022","journal-title":"JAMA Oncol"},{"issue":"6","key":"soi240045r23","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1177\/000313481608200615","article-title":"Transanal pull-through procedure with delayed versus immediate coloanal anastomosis for anus-preserving curative resection of lower rectal cancer: a case-control study.","volume":"82","author":"Xiong","year":"2016","journal-title":"Am Surg"},{"issue":"1-2","key":"soi240045r24","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1111\/ans.16412","article-title":"Turnbull-Cutait technique without ileostomy after total mesorectal excision is associated with acceptably low early post-operative morbidity.","volume":"91","author":"Guner","year":"2021","journal-title":"ANZ J Surg"},{"key":"soi240045r25","doi-asserted-by":"publisher","first-page":"104","DOI":"10.4274\/tjcd.galenos.2020.2020-1-5","article-title":"An old method TurnbullCutait; using for middle and distal rectal cancer surgery without ileostomy. Oncological and functional late outcomes.","volume":"30","author":"Guner","year":"2020","journal-title":"Turk J Colorectal Dis"}],"container-title":["JAMA Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/articlepdf\/2821020\/jamasurgery_biondo_2024_oi_240045_1725986248.7899.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,11]],"date-time":"2024-09-11T15:38:12Z","timestamp":1726069092000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/fullarticle\/2821020"}},"subtitle":["A Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2024,9,1]]},"references-count":25,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2024,9,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamasurg.2024.2262","relation":{},"ISSN":["2168-6254"],"issn-type":[{"value":"2168-6254","type":"print"}],"subject":[],"published":{"date-parts":[[2024,9,1]]}}}