Intra-operative Rectal Washout with Saline Can Effectively Prevent Anastomotic Recurrence: a Meta-analysis

Improvements in surgery and the application of combined approaches to fight rectal cancer have succeeded in reducing the anastomotic recurrences (AR), which is relatively rare among pelvic recurrences of rectal cancer following surgical resection, ranging 2.4% from 12% of all patients who underwent colorectal anastomosis (Li Destri et al., 2011). Nevertheless, anastomotic recurrence of rectal cancer remains a significant clinical problem, yields fatal outcomes that associated with severe morbidity, low rates of success of salvage procedures, and eventual death in the majority of patients (Kaiser et al., 2006; EnríquezNavascués et al., 2011). One theory for AR is that viable tumor cells, which are shed from the surface of solid tumor tissue in the lumen of the rectum during anterior resection, may be responsible for some locoregional anastomotic recurrences (Tsunoda et al., 1997). It was hypothesized one hundred years ago that “liberated cancer cells” may cause recurrence after surgery for rectal cancer (Turner et al., 1948; Goligher et al., 1951) and most surgeons today continue to avoid touching or manipulating a tumor excessively, so as not to spread malignant cells inside or outside the bowel. The implantation of malignant cells tends to occur when the mucosal surface is damaged (Hubens et al., 1994). Braided sutures are also capable of entrapping and transferring large numbers of free intra-luminal tumor cells in vivo (Umpleby et al., 1984; Skipper et al., 1987; McGregor et