EP853 - Outcomes After the Turnbull–Cutait Abdominoperineal Pull-Through Operation.

ePoster Presenter(s)

• 

  Amirbahador Abbasi, MD, MPH

  Postdoctoral Research Fellow
  Global Center for Integrated Colorectal Surgery & IBD Interventional Endoscopy Columbia University Irving Medical Center / New York Presbyterian Hospital
  Columbia University Irving Medical Center / New York Presbyterian Hospital
  New York, NY, United States

  Disclosure information not submitted.

Author(s)

• BC

  Beatrix H. Choi, MD

  Resident Physician
  Global Center for Integrated Colorectal Surgery & IBD Interventional Endoscopy Columbia University Irving Medical Center / New York Presbyterian Hospital
  Columbia University Medical Center
  New York, New York, United States

  Disclosure information not submitted.
• DK

  Dilara Khoshknabi, MD

  Consultant
  Global Center for Integrated Colorectal Surgery & IBD Interventional Endoscopy Columbia University Irving Medical Center / New York Presbyterian Hospital
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• JC

  James M. Church, MD

  Professor of Surgery
  Global Center for Integrated Colorectal Surgery & IBD Interventional Endoscopy Columbia University Irving Medical Center / New York Presbyterian Hospital
  Leola, Pennsylvania, United States

  Disclosure information not submitted.
• BS

  Bo Shen, MD

  Professor of Medicine and Surgical Sciences
  Global Center for Integrated Colorectal Surgery & IBD Interventional Endoscopy Columbia University Irving Medical Center / New York Presbyterian Hospital
  New York, New York, United States

  Disclosure information not submitted.

Senior Author(s)

• RK

  Ravi P. Kiran, MD

  Professor of Surgery
  Global Center for Integrated Colorectal Surgery & IBD Interventional Endoscopy Columbia University Irving Medical Center / New York Presbyterian Hospital
  New York, New York, United States

  Disclosure information not submitted.

Purpose/Background: The Turnbull-Cutait (TC) abdominoperineal pull-through with delayed coloanal anastomosis is a rarely performed alternative in complex pelvic cases when immediate anastomosis is high risk or not feasible. Although it can avoid a permanent stoma, contemporary data on perioperative safety and long-term durability are limited.

Methods/Interventions: We retrospectively reviewed all patients undergoing the TC procedure at a referral center between 2014 and 2025 using a prospectively maintained database. Demographics, operative details, and 30-day outcomes were recorded. Long-term outcomes included anastomotic stricture, leak, fistula, abscess, incontinence, and permanent diversion. Stoma-free survival was assessed with Kaplan-Meier analysis.

Results/Outcomes: Eight patients (median age 61.9 years, BMI 22.9; 62.5% female) underwent TC. Indications included rectal cancer (62.5%), diverticulitis (12.5%), cervical cancer (12.5%), and prostatic cancer (12.5%). Median operative time was 268 minutes with median blood loss 200 ml. Two cases were initiated laparoscopically, with one conversion.

At 30 days, median length of stay was 8.5 days. No readmissions, reoperations, or deaths occurred. Postoperative morbidity included transfusion (50%), ileus (37.5%), renal complications (37.5%), and surgical site infection (12.5%), without early anastomotic leak or abscess.

At a median follow-up of 41 months (IQR 18-77), late morbidity included anastomotic stricture in 5 patients (62.5%), often requiring endoscopic or surgical management. Fistula formation was seen in 5 patients (62.5%), while 3 patients (37.5%) developed pelvic abscesses. A delayed anastomotic leak was documented in 1 patient (12.5%). One patient (12.5%) reported fecal incontinence. Ultimately, 3 patients (37.5%) required permanent fecal diversion. Kaplan-Meier analysis demonstrated stoma-free survival of 87.5% at 7 months, 75% at 1 year, and 62.5% at 3 years, with mean stoma-free survival of 49.3 months (95% CI, 27.5-71.2).

Conclusion/Discussion: The TC procedure that is often a last resort to avoid a permanent ostomy can be performed with short-term safety with no leaks or mortality. While long-term outcomes are limited by high stricture and fistula rates, two thirds of patients remain stoma free at 3 years suggesting that it is a viable option to avoid a permanent ostomy in carefully selected patients after careful counseling about the risks.

Table 1: Characteristics and Outcomes of Patients Following Turnbull-Cutait Procedure.
BMI, body mass index; IQR, interquartile range; LOS, length of stay; SSI, surgical site infection.
Figure 1. Kaplan-Meier Curve of Stoma-Free Survival After Turnbull-Cutait Procedure