Modified Albert–Lembert coloanal anastomosis with diverting ileostomy versus Turnbull–Cutait pull-through delayed coloanal anastomosis after intersphincteric resection for low rectal cancer: a single-center retrospective comparative study

Abstract Background Reconstruction after intersphincteric resection (ISR) for low rectal cancer remains technically challenging. Turnbull–Cutait pull-through delayed coloanal anastomosis (DCAA) has been used as a sphincter-preserving delayed reconstructive strategy, but it requires exteriorization of the colon and a planned second-stage perineal procedure. To improve anastomotic stability after ISR, we performed modified Albert–Lembert coloanal anastomosis (MALA) with diverting ileostomy. This study aimed to compare the short-term clinical outcomes of MALA with diverting ileostomy versus DCAA after ISR for low rectal cancer. Methods This single-center retrospective comparative study was conducted at Henan Provincial People’s Hospital. Between February 2023 and October 2025, consecutive patients with low rectal cancer who underwent laparoscopic ISR followed by hand-sewn coloanal anastomosis were reviewed. Among them, 58 patients underwent Turnbull–Cutait pull-through delayed coloanal anastomosis (DCAA group), and 42 patients underwent modified Albert–Lembert one-stage coloanal anastomosis with diverting ileostomy (MALA group). Clinical outcomes were compared between the two groups. The primary outcome was overall postoperative morbidity within 30 days after the first surgery. Results A total of 100 patients were included, with 58 in the DCAA group and 42 in the MALA group. Baseline demographic, clinical, and tumor characteristics were comparable between the two groups. The 30-day overall postoperative morbidity rates were 32.8% and 23.8% in the DCAA and MALA groups, respectively, with no statistically significant between-group difference ( P = 0.378). No statistically significant differences were observed in the rates of Clavien–Dindo grade I–II complications (19.0% vs. 16.7%, P = 0.799) or grade III or higher complications (13.8% vs. 7.1%, P = 0.350). Operative time (201.8 ± 28.6 min vs. 206.5 ± 32.4 min, P = 0.463), intraoperative blood loss [60 mL (range, 30–150) vs. 60 mL (range, 30–110), P = 0.408], harvested lymph nodes [19 (range, 15–23) vs. 22 (range, 16–24), P = 0.356], R0 resection rate (100% vs. 100%, P = 1.000), and postoperative hospital stay [15 days (range, 13–21) vs. 14 days (range, 12–20), P = 0.225] did not differ significantly between the two groups. Conclusions MALA with diverting ileostomy is a technically feasible sphincter-preserving reconstructive strategy in selected patients undergoing laparoscopic ISR for low rectal cancer, and no statistically significant difference in 30-day postoperative morbidity was observed between the MALA and DCAA groups.