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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 Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston
  • 2Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston
  • 3Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
JAMA Surg. 2021;156(2):202-203. doi:10.1001/jamasurg.2020.5189

To the Editor: Biondo et al1 evaluated the efficacy of 2-stage Turnbull-Cutait pull-through hand-sewn coloanal anastomosis (TC) vs standard hand-sewn coloanal anastomosis (SHS).1 The primary end point was 30-day postoperative morbidity. A total of 92 patients were randomized in a 1:1 ratio, presumably to detect a potential difference of 30.5% in morbidity rate between the 2 arms. The observed rates were 34.8% and 45.7% for TC and SHS. The difference (TC minus SHS) was −10.9%, which was much lower than the difference assumed at the design stage. The study was underpowered, resulting in a very large 95% CI that suggested the true difference between the 2 groups ranged from −29.5% to 8.9%.

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