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Transverse Coloplasty Pouch versus Straight Coloanal Anastomosis Following Intersphincteric Resection for Low Rectal Cancer: the Functional Benefits May Emerge After Two Years

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Journal of Gastrointestinal Surgery

Abstract

Purpose

This study aimed to compare the oncological and functional outcomes following intersphincteric resection (ISR) with transverse coloplasty pouch (TCP) or straight coloanal anastomosis (SCAA) for low rectal cancer.

Methods

A single-center retrospective analysis was performed on patients with low rectal cancer who received ISR between January 2016 and June 2021. The primary endpoint was to compare the outcomes of bowel function within 1 year, 1 to 2 years, and 2 years after ileostomy closure in patients undergoing two different bowel reconstruction procedures (TCP or SCAA). The postoperative complications and oncological results were also compared between the two groups.

Results

A total of 235 patients were enrolled in this study (SCAA group: 166; TCP group: 69). There was no significant difference in complications, including grades A–C anastomotic leakage (9.6% vs 15.9%), 3-year local recurrence rates (6.1% vs 3.9%), disease-free survival (82.4%vs 83.8%), or overall survival (94.1% vs 94.7%) between the two groups. Two years after ileostomy closure, 52.7% of patients in the SCAA group were assessed as having major low anterior resection syndrome (LARS), which was significantly higher than the 25.9% of patients in the TCP group (P = 0.014), but no difference was found prior to 2 years. Similar differences were seen in Wexner scores 2 years after surgery (P = 0.032). Additionally, TCP was an independent protective factor for postoperative bowel function as measured by both the LARS (OR, 0.28; 95% CI, 0.10–0.82; p = 0.020) and Wexner scoring (OR, 0.28; 95% CI, 0.09–0.84; p = 0.023).

Conclusion

This study suggests that TCP is a safe technique that may decrease bowel dysfunction after ISR for low rectal cancer compared with SCAA 2 years after ileostomy closure.

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Acknowledgments

The authors thank all the staff at the Department of Colorectal Surgery, Fujian Medical University Union Hospital (FMUUH, Fuzhou, China).

Funding

Joint funds for the innovation of science and technology in Fujian province (2017Y9038, 2019Y9101, 2020Y9071); Fujian Provincial Health Technology Project (2020GGB022, 2020CXA025)； Natural Science Foundation of Fujian Province (2020J011030, 2022J01753); Medical Science Research Foundation of Beijing Medical and Health Foundation(B20062DS); Bethune Charitable Foundation(X-J-2018-004).

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Author notes

  1. Pan H, Zhao Z, and Deng Y contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Colorectal Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China

    Hongfeng Pan, Zeyi Zhao, Yu Deng, Zhifang Zheng, Ying Huang, Pan Chi & Shenghui Huang

  2. Training center of minimally invasive surgery, Fujian Medical University Union Hospital, Fuzhou, China

    Hongfeng Pan, Zeyi Zhao, Yu Deng, Zhifang Zheng, Ying Huang, Pan Chi & Shenghui Huang

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  1. Hongfeng Pan
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Contributions

HP, ZZha, SH, YH, and PC conceived and designed the project. HP and YD collected the data. ZZha and ZZhe analyzed and interpreted the data. HP and SH drafted the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ying Huang, Pan Chi or Shenghui Huang.

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Supplementary Information

Esm 1:

Supplemental Figure 1. Flow chart of the study. (TIF 2423 kb)

Esm 2:

Supplemental Figure 2. Construction of the transverse coloplasty pouch (TCP). For creation of the TCP, a 5cm longitudinal incision was made 5cm proximally to the colon resection margin(a), and transverse suture was performed (b). (TIF 2007 kb)

Esm 3:

Supplemental Figure 3 Postoperative gastrografin enema for patients who underwent intersphincteric resection with transverse coloplasty pouch (TCP). (TIFF 1056 kb)

Esm 4

Table S1. Postoperative complications after intersphincteric resection with SCAA or TCP. (DOCX 14 kb)

Esm 5

Table S2. Functional outcomes of SCAA and TCP. (DOCX 14 kb)

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Pan, H., Zhao, Z., Deng, Y. et al. Transverse Coloplasty Pouch versus Straight Coloanal Anastomosis Following Intersphincteric Resection for Low Rectal Cancer: the Functional Benefits May Emerge After Two Years. J Gastrointest Surg 27, 2526–2537 (2023). https://doi.org/10.1007/s11605-022-05565-w

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