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Comment & Response
November 11, 2020

Two-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Low Rectal Cancers

Author Affiliations
  • 1Department of Surgery, University of Modena, Modena, Italy
  • 2Department of Pathology, University of Modena, Modena, Italy
JAMA Surg. 2021;156(2):201-202. doi:10.1001/jamasurg.2020.5174

To the Editor The Biondo et al1 article reports results of the Turnbull-Cutait pull-through 2-stage hand-sewn coloanal anastomosis (TCA), compared with those of the standard hand-sewn coloanal anastomosis (CAA).1 In this context, some anatomo-functional problems deserve to be discussed. At first, in evaluating the functional aspects of each restorative rectal surgery, the negative effect of a high-dose neoadjuvant radiotherapy on the muscular fibers of the anal sphincter and on their nervous and microvascular apparatuses has to be considered, among other basic conditions, when included in the radiation field.2 Second, internal sphincter resections, sometimes associated with a CAA, adversely affect the anal continence differently from the anal canal mucosectomy realized in TCA. Third, a colonic J pouch, not foreseen in TCA, can improve the anal function differently from the rectal cuff when used in ultralow anterior rectal resection realized with a mechanical double-stapled anastomosis.

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