Reappraisal of pull-through delayed colo-anal anastomosis for surgical treatment of low rectal cancer: do we have to look back to go forward?

Surgical treatment of low rectal cancer through total mesorectal excision (TME) and colo-anal anastomoses (CAA) still represents a challenge for surgeons and, on patients’ side, it might result into a reduction of their self-perception and quality of life. Standard one stage CAA (both mechanical and manual) with concomitant prophylactic ileostomy is currently considered the standard of care for reconstruction after low anterior resection with TME for ultra-low rectal cancer.