The surgical treatment of rectal cancer remains a challenge for surgeons. Currently, the treatment of choice for mid/lower rectal cancer is ultralow anterior resection with coloanal anastomosis. However, this type of anastomosis carries a high risk of leakage, which can reach up to 30% [1], and consequently, pelvic sepsis. Following such complications, the percentage of patients who ultimately require a permanent stoma can be significant. At this point, pull‐through surgery using the Turnbull–Cutait technique has regained special interest.
We present the case of a 62‐year‐old woman diagnosed with a mid‐rectal adenocarcinoma (8 cm from the anal verge), TNM: cT3pN1M0.
She underwent total neoadyuvant treatment, followed by surgical treatment with robotic ultralow anterior resection, handsewn coloanal anastomosis and protective lateral ileostomy.
Twelve days after the procedure, an anastomotic leak affecting more than 80% of the anastomosis was detected, associated with a 4 cm pelvic collection.
It was decided to perform a reoperation using a pull‐through procedure based on the Turnbull–Cutait technique, aiming to preserve sphincter function and avoid a permanent stoma.
The surgical intervention was performed in two consecutive stages:
First stage: transabdominal approach via robotic surgery + perineal pull‐through.
Second stage (after 7 days): resection of the distal segment and handsewn coloanal anastomosis.
The Turnbull–Cutait pull‐through procedure is emerging as a safe and reproducible alternative for managing complications and anastomotic leaks after ultralow anterior resections. It demonstrates good preservation of sphincter function, with similar morbidity and complication rates to ultralow resections [2] and offers an option to avoid the creation of a permanent stoma in selected patients [3].
AUTHOR CONTRIBUTIONS
Damián García Olmo: Validation; visualization; conceptualization; writing – original draft; writing – review and editing; supervision. Miguel León Arellano: Conceptualization; writing – original draft; writing – review and editing; validation; visualization; supervision; methodology. Héctor Guadalajara Labajo: Conceptualization; validation; visualization; writing – original draft; writing – review and editing. Enrique Rojo Villardón: Conceptualization; validation; writing – review and editing; writing – original draft; visualization. Mario Ortega López: Conceptualization; validation; visualization; writing – original draft; writing – review and editing.
FUNDING INFORMATION
This research has not received specific funding from public sector agencies, the commercial sector or non‐profit entities.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflicts of interest.
ETHICS STATEMENT
This manuscript describes a single clinical case. Written informed consent was obtained from the patient for the surgical procedure. According to our institutional policy, Institutional Review Board approval was not required for this single case report. All patient data presented in the manuscript and accompanying video have been fully anonymized.
DATA AVAILABILITY STATEMENT
No new data were generated or analysed in support of this article. All relevant material is included within the manuscript and the accompanying Video 1.
VIDEO 1.
Robotic Turnbull–Cutait pull‐through performed as a salvage procedure for a failed colorectal anastomosis. The video demonstrates a complex robotic pelvic dissection and colonic mobilization during the first stage of the procedure, followed by delayed handsewn coloanal anastomosis performed 7 days later. Transanal exteriorization of the rectal stump, representing the first step of the Turnbull–Cutait procedure. Video content can be viewed at https://onlinelibrary.wiley.com/doi/10.1111/codi.70559.
REFERENCES
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
No new data were generated or analysed in support of this article. All relevant material is included within the manuscript and the accompanying Video 1.
VIDEO 1.
Robotic Turnbull–Cutait pull‐through performed as a salvage procedure for a failed colorectal anastomosis. The video demonstrates a complex robotic pelvic dissection and colonic mobilization during the first stage of the procedure, followed by delayed handsewn coloanal anastomosis performed 7 days later. Transanal exteriorization of the rectal stump, representing the first step of the Turnbull–Cutait procedure. Video content can be viewed at https://onlinelibrary.wiley.com/doi/10.1111/codi.70559.