SP10.8 An overlooked step in colorectal cancer anastomosis: a potentially small step in prevention of exfoliated malignant cells

Abstract

Abstract Introduction Recurrence after potentially curative surgery has a significant clinical impact with a related poor prognosis. There is an abundance of literature surrounding efficacious techniques for anastomosis. However, to our knowledge comparatively there is minimal evidence reviewing the use of simple anti-septic agents with concurrent cytotoxic properties (ie. betadine or cetrimide) in prevention of anastomotic recurrence. This is despite both historic and newer evidence demonstrating tumour implantation of exfoliated malignant cells (EMCs) at the site of anastomosis leading to recurrence. This is also evident in low grade cancers. Methods A literature search was conducted between January 1980 to January 2022. The studies were to incorporate the use of simple anti-septic agents that were swabbed on the ends of the bowel before anastomosis. The search was restricted to articles published in English. Further more the selected publications were searched for additional studies. Results A result of 243 papers were reviewed, observational studies were found, n- 24. The reported reduction in EMCs was significantly lower at only 2 -7% compared to 16 to 55% in the control groups. Also evidenced were multiple papers providing significant experimental evidence of EMCs on staplers, gloves and the bowel anastomosed. We excluded rectal irrigation from this review article, as it is not employing the method of delivery suitable for all colonic anastomoses. Conclusion These results supporting the theory that cleansing with a cytocidal agent is associated with significantly reduced incidence of local luminal recurrence. We propose that this overlooked step in anastomotic techniques should be revisited.