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

Abstract

We thank the authors for their comments on our article. We discuss the points highlighted in the letters. Regarding technique and homogeneity of the groups, we stress that only patients with rectal cancer who are candidates for ultralow anterior rectal resection with sphincter preservation and hand-sewn coloanal anastomosis (CAA) were considered for inclusion. Indicating an intersphincteric resection does not depend on the chosen anastomosis but on the lower distance of the tumor from the anal canal. This scenario was homogeneous between groups. Therefore, neither radiotherapy nor intersphincteric approach or characteristics of the rectal dissection were confounding issues. Vascular ligation, restricted to inferior mesenteric artery, splenic flexure mobilization, and mesorectum dissection did not differ depending on the type of anastomosis. Ischemia cannot be attributed to technical differences between anastomotic techniques. We no longer perform a pouch technique after the evidence of long-term scarce benefits.