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Surgeon influenced variables in resectional rectal cancer surgery

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Diseases of the Colon & Rectum

Abstract

PURPOSE: Surgeon influenced variables in rectal cancer surgery were assessed. METHODS: The literature was reviewed to discuss technical and educational issues that may affect the outcome of surgery for rectal cancer. Particular attention was paid to recently debated topics such as adjuvant therapy, colonic J-pouches, total mesorectal excision, and surgeons' training. RESULTS: In some selected cases, transanal techniques with or without neoadjuvant or adjuvant therapy have improved the success of local excision. The biology of rectal cancer has begun to be understood. However, until a more complete understanding with an appreciation of therapeutic implications has been arrived at, surgeon influenced variables will continue to be of paramount importance. Multiple studies have shown tremendous surgeon variability in the outcome after rectal cancer surgery. Some of the variables that have been shown to be important include tumor-free distal and lateral margins, a total mesorectal excision, and an appropriate anastomosis. It has been well demonstrated that proctectomy with straight coloanal anastomosis compromises function as compared with preoperative levels or healthy controls. These deficiencies are further exacerbated by adjuvant therapy. Significant functional improvements, particularly in the first 12 to 24 months after surgery, have been achieved with use of colonic J-pouch. CONCLUSION: There are many ways by which the surgeon can optimize curative resection for rectal cancer. Appropriate distal and tumor-free lateral margins with total mesorectal excision should be the goals for all tumors in the lower two-thirds of the rectum. Reconstruction should be performed, whenever technically possible, by a colonic J-pouch. Surgeons should be cognizant of their own practice patterns, volume, capabilities, and very importantly results. These results should be audited frequently and willingly shared with patients.

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References

  1. Wingo PA, Tong T, Bolden S. Cancer statistics 1995. CA-a Cancer J Clin 1995;45:8–30.

    Google Scholar 

  2. Sprangers MA, Total BG, Aaronson NK, te Velde A. Quality of life in colorectal cancer: stoma versus nonstoma patients. Dis Colon Rectum 1995;38:361–9.

    Google Scholar 

  3. Williams NS, Johnston D. The quality of life after rectal excision for low rectal cancer. Br J Surg 1983;70:460–2.

    Google Scholar 

  4. Yarbro JW, Page DL, Fielding LP, Partridge EE, Murphy GP. American Joint Committee on cancer prognostic factors consensus conference. Cancer 1999;86:2436–46.

    Google Scholar 

  5. Magdeburg B, Fried M, Meyenberger C. Endoscopic ultrasonography in the diagnosis, staging, and follow-up of anal carcinoma. Endoscopy 1999;31:359–64.

    Google Scholar 

  6. Willet CG, Shellito PC, Tepper JE,et al. Intraoperative irradiation therapy for primary locally advanced rectal and rectosigmoid carcinomas. J Clin Oncol 1991;9:843–9.

    Google Scholar 

  7. Fletcher PR, DuQuesnay DR, Carpenter R. Treatment of low rectal carcinoma by transanal electrocoagulation. West Indian Med J 1999;48:147–9.

    Google Scholar 

  8. Sultan RA, Fallouh H. Low rectum inoperable carcinoma. Advantages of direct access in palliative laser treatment. J Clin Laser Med Surg 1991;9:29–33.

    Google Scholar 

  9. Kashtan H, Haddad R, Yossiphov Y, Bar-On S, Skornick Y. Photodynamic therapy of colorectal cancer using a new light source: fromin vitro studies to a patient treatment. Dis Colon Rectum 1996;39:379–83.

    Google Scholar 

  10. Goligher JC, ed. Surgery of the anus, rectum, and colon. 4th ed. London: Balliere Tindall, 1980.

    Google Scholar 

  11. Renner K, Rosen HR, Novi G, Holbling N, Schiesel R. Quality of life after surgery for rectal cancer: do we still need a permanent colostomy? Dis Colon Rectum 1999;42:1160–7.

    Google Scholar 

  12. Parks R, Percy JP. Resection and sutured colo-anal anastomosis for rectal carcinoma. Br J Surg 1982;69:301–4.

    Google Scholar 

  13. Hojo F, Koyama Y, Moriya Y. Lymphatic spread and its prognostic value in patients with rectal cancer. Am J Surg 1982;144:350–4.

    Google Scholar 

  14. Banerjee AK, Jhele EC, Shorthouse AJ, Buess G. Local excision of rectal tumors. Br J Surg 1995;82:1165–73.

    Google Scholar 

  15. Morson BC. Factors influencing the prognosis of early cancer of the rectum. J R Soc Med 1966;59:607–8.

    Google Scholar 

  16. Saclarides TJ, Bhattacharyya AK, Britton-Kuzel C, Szeluga D, Economou SG. Predicting lymph node metastases in rectal cancer. Dis Colon Rectum 1994;37:52–7.

    Google Scholar 

  17. Billingham RP. Conservative treatment of rectal cancer. Cancer 1992;70:1355–63.

    Google Scholar 

  18. Killingback MJ. Local excision of carcinoma of the rectum: indications. World J Surg 1992;16:437–46.

    Google Scholar 

  19. Liu SK, Church JM, Lavery IC, Fazio VW. Operation in patients with incurable colon cancer—is it worth-while? Dis Colon Rectum 1997;40:11–4.

    Google Scholar 

  20. Kim DG, Madoff RD. Transanal treatment of rectal cancer: ablative methods and open resection. Semin Surg Oncol 1998;15:101–13.

    Google Scholar 

  21. Chandler PJ, Okin B. Rectal carcinoma: operative treatment. In: Beck DE, Wexner SD, eds. Fundamentals of anorectal surgery. Philadelphia: WB Saunders, 1998:301–67.

    Google Scholar 

  22. Varma MG, Rogers SJ, Schrock TR, Welton ML. Local excision of rectal carcinoma. Arch Surg 1999;143:863–8.

    Google Scholar 

  23. Brodsky JT, Richard GK, Cohen AM, Minsky BD. Variables correlated with the risk of lymph node metastases in early rectal cancer. Cancer 1992;69:322–6.

    Google Scholar 

  24. Bailey HR, Huval WV, Max E, Smith KW, Butts DR, Zamora LF. Local excision of carcinoma of the rectum for cure. Surgery 1992;111:555–61.

    Google Scholar 

  25. Abel ME, Rosen L, Kodner IJ,et al. The Standards Task Force, American Society of Colon and Rectal Surgeons. Practice parameters for the treatment of rectal carcinoma—supporting documentation. Dis Colon Rectum 1993;36:991–1006.

    Google Scholar 

  26. Graham RA, Garnsey L, Jessup JM. Local excision of rectal carcinoma. Am J Surg 1989;160:306–12.

    Google Scholar 

  27. Whiteway J, Nicholls RJ, Morson BC. The role of surgical local excision for early cancer of the colorectum. Br J Surg 1985;72:694–7.

    Google Scholar 

  28. Killingback MJ. Indications for local excision of rectal cancer. Br J Surg 1985;72:S54–6.

    Google Scholar 

  29. Morson BC, Bussey HJ, Samoorian S. Policy of local excision for early cancer of the colorectum. Gut 1977;18:1045–50.

    Google Scholar 

  30. Bennett CJ Jr, Sombeck MD, Mendenhall WM, Million RR, Bland KL, Copeland EM 3rd. Conservative alternatives in the management of early adenocarcinoma of the rectum. South Med J 1993;86:409–13.

    Google Scholar 

  31. Buess G, Hutterer J, Theiss M, Bobel W, Isselhard W, Pilchmaier H. Das System fur die transanale, endoscopische Rektumoperation. Chirurg 1984;55:677.

    Google Scholar 

  32. Smith LE, Ko ST, Saclarides T, Caushaj P, Orkin BA, Khanduja KS. Transanal endoscopic microsurgery: initial registry results. Dis Colon Rectum 1996;39:S79–84.

    Google Scholar 

  33. Winde G, Nottberg H, Keller R, Schmid KW, Bunte H. Surgical cure for early rectal carcinoma (T1): transanal endoscopic microsurgeryvs anterior resection. Dis Colon Rectum 1996;39:969–76.

    Google Scholar 

  34. Heintz A, Morschel M, Junginger T. Comparison of results after transanal endoscopic microsurgery and radical resection for T1 carcinoma of the rectum. Surg Endosc 1998;12:1145–8.

    Google Scholar 

  35. Eisenstat TE, Oliver GC. Electrocoagulation for adenocarcinoma of the low rectum. World J Surg 1992;16:458–62.

    Google Scholar 

  36. Papillon J, Berard P. Endocavity irradiation in the conservative treatment of adenocarcinoma of the low rectum. World J Surg 1992;16:451–7.

    Google Scholar 

  37. Kodner IJ, Gilley MT, Shemesh EI, Fleshman JW, Fry RD, Myerson RJ. Radiation therapy as definitive treatment for selected invasive rectal cancer. Surgery 1993;114:850–6.

    Google Scholar 

  38. Hull TL, Lavery IC, Saxton JP. Endocavitary irradiation: an option in select patients with rectal cancer. Dis Colon Rectum 1994;37:1266–70.

    Google Scholar 

  39. Baron PL, Enker WE, Zakowski MF, Urmacher C. Immediatevs. salvage resection after local treatment for early rectal cancer. Dis Colon Rectum 1995;38:177–81.

    Google Scholar 

  40. Minsky BD, Cohen AM, Enker WE, Paty P. Sphincter preservation with preoperative radiation therapy and coloanal anastomosis. Int J Radiat Oncol Biol Phys 1995;31:553–9.

    Google Scholar 

  41. Mentges B, Buess G, Schafer D, Manncke K, Becker HD. Local therapy of rectal tumors. Dis Colon Rectum 1996;39:886–92.

    Google Scholar 

  42. Bleday R, Breen E, Jessup JM, Burgess A, Sentovich SM, Steele G Jr. Prospective evaluation of local excision for small rectal cancers. Dis Colon Rectum 1997;40:388–92.

    Google Scholar 

  43. Muto T, Nagawa H, Watanabe T, Masaki T, Sawada T. Colorectal carcinogenesis: historical review. Dis Colon Rectum 1997;40:S80–5.

    Google Scholar 

  44. Herrera L, Kakati S, Gibas L, Pietrzak E, Sanberg AA. Gardner syndrome in a man with an interstitial deletion of 5q. Am J Med Genet 1986;25:473–6.

    Google Scholar 

  45. Bordmer WF, Bailey CJ, Bodmer J,et al. Localization of the gene for familial adenomatous polyposis on chromosome 5. Nature 1987;328:614–6.

    Google Scholar 

  46. Vogelstein B, Fearon ER, Hamilton SR,et al. Genetic alterations during colorectal tumor development. N Engl J Med 1988;319:525–32.

    Google Scholar 

  47. Glarakis IS, Savva S, Spandidos DA. Activation of the ras genes in malignant and premalignant colorectal tumors. Oncol Rep 1998;5:1451–4.

    Google Scholar 

  48. Senagore AJ, Biener JT. A newly identified pattern of K-ras mutations at codons 12 and 13 is associated with long-term survival in colorectal cancer. Surgery 1997;122:765–70.

    Google Scholar 

  49. Pajkos G, Kiss I, Sandor J, Ember I, Kishazi P. Prognostic value of the presence of the mutation of the codons 12, 13 and 61 in K-ras oncogene in colorectal cancer. Orv Hetil 1999;140:1673–9.

    Google Scholar 

  50. Liang JT, Cheng YM, Chang KJ, Chien CT, Hsu HC. Reappraisal of K-ras and p53 gene mutations in the recurrence of Dukes' B2 rectal cancer after curative resection. Hepatogastroenterology 1999;46:830–7.

    Google Scholar 

  51. Spitz FR, Giacco GG, Hess K,et al. P53 immunohistochemical staining predicts residual disease after chemoradiation in patients with high-risk rectal cancer. Clin Cancer Res 1997;3:1685–90.

    Google Scholar 

  52. Jessup JM, Loda M. Prognostic markers in rectal carcinoma. Semin Surg Oncol 1998;15:131–40.

    Google Scholar 

  53. Sato T, Nishimura G, Fushida S,et al. Evaluation of p53, Ki67 and DNA ploidy in both primary rectal carcinoma and locally recurrent tumors. Oncol Rep 1998;5:1225–9.

    Google Scholar 

  54. Elsaleh H, Soontrapornchai P, Grieu F, Joseph D, Iacopetta B. P53 alterations have no prognostic or predictive significance in Dukes C rectal carcinomas. Int J Oncol 1999;15:1239–43.

    Google Scholar 

  55. Adell G, Sun XF, Stal O, Klintenberg C, Sjödahl R, Nordenskjöld B. P53 status: an indicator for the effect of preoperative radiotherapy of rectal cancer. Radiother Oncol 1999;51:169–74.

    Google Scholar 

  56. Nehls O, Klump B, Holzmann K,et al. Influence of p53 status on prognosis in preoperatively irradiated rectal carcinoma. Cancer 1999;85:2541–8.

    Google Scholar 

  57. Reymond MA, Dworak O, Remke S, Hohenberger W, Kirchner T, Köckerling F. DCC protein as a predictor of distant metastases after curative surgery for rectal cancer. Dis Colon Rectum 1998;41:755–60.

    Google Scholar 

  58. Relman AS. Assessment and accountability. The third revolution in medical care. N Engl J Med 1988;319:1220–2.

    Google Scholar 

  59. Goldstein ET. Outcomes of anorectal disease in a health maintenance organization: setting the need for colorectal surgeons. Dis Colon Rectum 1996;39:1193–8.

    Google Scholar 

  60. Rosen L, Stasik JJ Jr, Read JF III, Olenwine JA, Aronoff JS, Sherman D. Variations in colon and rectal surgical mortality. Comparison of specialties with statelegislated data base. Dis Colon Rectum 1996;39:129–35.

    Google Scholar 

  61. Luft HS, Bunker JP, Enthoven AC. Should operations be regionalized? The empirical relationship between surgical volume and mortality. N Engl J Med 1979;301:1364–9.

    Google Scholar 

  62. Dorrance H, O'Dwyer J. Effect of the surgeon's specialty interest on outcome after curative colorectal cancer surgery [abstract]. Br J Surg 1997;84:16.

    Google Scholar 

  63. McArdle CS, Hole D. Impact of variability among surgeons on postoperative morbidity and mortality and ultimate survival. BMJ 1991;302:1501–5.

    Google Scholar 

  64. Hermanek P, Hohenberger W. The importance of volume in colorectal cancer surgery. Eur Surg Oncol 1996;22:213–5.

    Google Scholar 

  65. Porter GA, Soskolne CL, Yaminets WW, Newman SC. Surgeon related factors and outcome in rectal cancer. Ann Surg 1998;227:157–67.

    Google Scholar 

  66. Latulippe JF, Wexner SD. Effect of colorectal board certification and volume on the costs of large bowel surgery. Asian Coll Surg 1999;3:33–9.

    Google Scholar 

  67. Harmon JW, Tang DG, Gordon TA,et al. Hospital volume can serve as a surrogate for surgeon volume for achieving excellent outcome in colorectal resection. Ann Surg 1999;230:404–13.

    Google Scholar 

  68. Wheeler HB. Myth and reality in general surgery. Bull Am Coll Surg 1993;78:21–7.

    Google Scholar 

  69. Ritchie WP, Rhodes RS, Biester TW. Work loads and practice patterns of general surgeons in United States, 1995–1997: a report from the American Board of Surgery. Ann Surg 1990;230:533–43.

    Google Scholar 

  70. Schoetz DJ Jr. Colon and rectal surgery: a true subspecialty. Dis Colon Rectum 1998;41:1–10.

    Google Scholar 

  71. Galandiuk S. A surgical subspecialist enhances general surgical operative experience. Arch Surg 1995;130:1136–8.

    Google Scholar 

  72. Steele RJ. The influence of surgeon case volume on outcome in site-specific cancer surgery. Eur J Surg Oncol 1996;22:211–3.

    Google Scholar 

  73. Phillips RK, Hittinger R, Blesovsy L, Fry JS, Fielding LP. Local recurrence following curative surgery for large bowel cancer. Br J Surg 1984;71:12–6.

    Google Scholar 

  74. Singh KK, Barry MK, Ralston P,et al. Audit of colorectal cancer surgery by non-specialist surgeons. Br J Surg 1997;84:343–7.

    Google Scholar 

  75. Hyman N. Impact of a colon and rectal surgeon on a residency training program [meeting abstract]. Dis Colon Rectum 1998;41:A54.

    Google Scholar 

  76. Goligher JC, ed. Surgery of the anus, rectum and colon. 5th ed. London: Balliere Tindall, 1984.

    Google Scholar 

  77. Handley WS. The surgery of the lymphatic system. BMJ 1910;1:922–8.

    Google Scholar 

  78. Cole PP. The intramural spread of the rectal carcinoma. BMJ 1913;1:431–3.

    Google Scholar 

  79. Grinnell RS. Distal intramural spread of carcinoma of the rectum an rectosigmoid. Surg Gynecol Obstet 1954;99:421–30.

    Google Scholar 

  80. Quer EA, Dahlin DC, Mayo CW. Retrograde intramural spread of carcinoma of the rectum and rectosigmoid. Surg Gynecol Obstet 1953;96:24–30.

    Google Scholar 

  81. Williams NS, Dixon MF, Johnston D. Reappraisal of the 5 cm rule of distal excision for carcinoma of the rectum: a study of distal intraumural spread and of patients' survival. Br J Surg 1983;170:150–4.

    Google Scholar 

  82. Deddish MR, Stearns MW. Anterior resection for carcinoma of the rectum and rectosigmoid area. Ann Surg 1961;154:961–6.

    Google Scholar 

  83. Wilson SM, Beahrs OH. The curative treatment of carcinoma of the sigmoid, rectosigmoid and rectum. Ann Surg 1976;183:556–65.

    Google Scholar 

  84. Pollett WG, Nicholls RJ. The relationship between the extent of distal clearance and survival and local recurrence rates after curative anterior resection for carcinoma of the rectum. Ann Surg 1983;198:159–63.

    Google Scholar 

  85. Vernava AM III, Moran M, Rothenberger DA, Wong WD. A prospective evaluation of distal margins in carcinoma of the rectum. Surg Gynecol Obstet 1992;175:333–6.

    Google Scholar 

  86. Wolmark N, Fischer B. An analysis of survival and treatment failure following abdominoperineal and sphincter saving resection in Dukes B and C rectal carcinoma. Ann Surg 1986;204:480–7.

    Google Scholar 

  87. Bozetti F, Mariani L, Miceli R,et al. Impact of distal margin on oncological outcome after restorative resection of the rectum. Tumori 1997;83:907–11.

    Google Scholar 

  88. Rubbini M, Vettorello GF, Guerrera C,et al. A prospective study of local recurrence after resection and low stapled anastomosis in 183 patients with rectal cancer. Dis Colon Rectum 1990;33:117–21.

    Google Scholar 

  89. Shirouzu K, Isomoto H, Kakegawa T. Distal spread of rectal cancer and optimal distal margin of resection for sphincter preserving surgery. Cancer 1995;76:388–92.

    Google Scholar 

  90. Andreola S, Leo E, Belli F,et al. Distal intramural spread in adenocarcinoma of the lower third of the rectum treated with total rectal resection and coloanal anastomosis. Dis Colon Rectum 1997;40:25–9

    Google Scholar 

  91. Yanagi H, Kusunoki M, Shoji Y, Yamamura T, Utsunomiya J. Preoperative detection of distal intramural spread of lower rectal carcinoma using transrectal ultrasonography. Dis Colon Rectum 1996;39:1210–4.

    Google Scholar 

  92. Kwok SP, Lau WY, Leung KL, Liew CT, Li AK. Prospective analysis of the distal margin of clearance in anterior resection for rectal carcinoma. Br J Surg 1996;83:969–72.

    Google Scholar 

  93. Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histologic study of later tumor spread and surgical excision. Lancet 1986;2:996–9.

    Google Scholar 

  94. Chan KW, Boey J, Wong SK. A method of reporting radial invasion and surgical clearance of rectal carcinoma. Histopathology 1985;9:1319–27.

    Google Scholar 

  95. Cawthorn SJ, Parums DV, Gibbs NM,et al. Extent of mesorectal spread and involvement of lateral resection margin as prognostic factors after surgery for rectal cancer. Lancet 1990;335:1055–9.

    Google Scholar 

  96. de Haas-Kock DF, Baeten CG, Jager JJ,et al. Prognostic significance of radial margins of clearance in rectal cancer Br J Surg 1996;83:781–5.

    Google Scholar 

  97. Hall NR, Finan PJ; Al-Jaberi T,et al. Circumferential margin involvement after mesorectal excision of rectal cancer with curative intent: predictor of survival but not local recurrence? Dis Colon Rectum 1998;41:979–83.

    Google Scholar 

  98. Karanjia ND, Schache DJ, North WR, Heald RJ. “Close shave” in anterior resection. Br J Surg 1990;77:510–2.

    Google Scholar 

  99. Arbman G, Nilsson E, Hallböök O, Sjödahl R. Local recurrence following total mesorectal excision for rectal cancer. Br J Surg 1996;83:375–9.

    Google Scholar 

  100. Colombo PL, Foglieni CL, Morone C. Analysis of recurrence following curative low anterior resection and stapled anastomoses for carcinoma of the middle third and lower rectum. Dis Colon Rectum 1987;30:457–64.

    Google Scholar 

  101. Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1986;1:1479–82.

    Google Scholar 

  102. Belli L, Beati CA, Frangi M, Aseni P, Rondinara GF. Outcome of patients with rectal cancer treated by stapled anterior resection. Br J Surg 1988;75:422–44.

    Google Scholar 

  103. Kirwan WO, O'Riordain MG, Waldron R. Declining indication for abdominoperineal resection. Br J Surg 1989;76:1061–3.

    Google Scholar 

  104. Mac Farlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet 1993;341:457–60.

    Google Scholar 

  105. Dixon AR, Maxwell WA, Thornton Holmes J. Carcinoma of the rectum: a 10 year experience. Br J Surg 1991;78:308–11.

    Google Scholar 

  106. Jatzko G, Lisborg P, Wette V. Improving survival rates for patients with colorectal cancer. Br J Surg 1992;79:588–91.

    Google Scholar 

  107. Moran BJ, Blenkinsop J, Finnis D. Local recurrence after anterior resection for rectal cancer using a double stapling technique. Br J Surg 1992;79:836–8.

    Google Scholar 

  108. Enker WE, Thaler HT, Cranor ML, Polyak T. Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 1995;181:335–46.

    Google Scholar 

  109. McCall JL, Cox MR, Wattchow DA. Analysis of local recurrence rates after surgery alone for rectal cancer. Int J Colorectal Dis 1995;10:126–32.

    Google Scholar 

  110. Moriya Y, Suihara K, Akasu T, Fujita S. Patterns of recurrence after nerve-sparing surgery for rectal adenocarcinoma with special reference to locoregional recurrence. Dis Colon Rectum 1995;38:1162–8.

    Google Scholar 

  111. Bjerkeset T, Edna TH. Rectal cancer: the influence of type of operation on local recurrence and survival. Eur J Surg 1996;162:643–8.

    Google Scholar 

  112. Aitken RJ. Mesorectal excision for cancer. Br J Surg 1996;83:214–6.

    Google Scholar 

  113. Leo E, Belli F, Andreola S. Total rectal resection, mesorectum excision, and coloendoanal anastomosis: a therapeutic option for the treatment of low rectal cancer. Ann Surg Oncol 1996;3:336–43.

    Google Scholar 

  114. Hallböök O, Påhlman L, Krog M, Wexner SD, Sjödahl R. Randomized comparison of straight and colonic J-pouch anastomosis after low anterior resection. Ann Surg 1996;224:58–65.

    Google Scholar 

  115. Carvalho N, Farrieha V, Giria J. Total mesorectal excision for rectal cancer [meeting abstract]. Br J Surg 1997;84(Suppl 2):27.

    Google Scholar 

  116. Hainsworth PJ, Egan J, Cunliffe WJ. Evaluation of a policy of total mesorectal excision for rectal and rectosigmoid cancers. Br J Surg 1997;84:652–6.

    Google Scholar 

  117. Bernstein MA, Amamath B, Weiss EG, Nogueras JJ, Wexner SD. Total mesorectal excision without adjuvant therapy for local control of rectal cancer: a North American experience. Techn Coloproctol 1998;2:11–5.

    Google Scholar 

  118. Heald RJ, Husband EM, Ryall RD. The mesorectum and rectal cancer the clue to pelvic resection? Br J Surg 1982;69:613–6.

    Google Scholar 

  119. Hill GL, Rafique M. Extrafascial excision of the rectum for rectal cancer. Br J Surg 1998;85:809–12.

    Google Scholar 

  120. Scott N, Jackson P, Al-Jaberi T, Dixon MF, Quirke P, Finan PJ. Total mesorectal excision and local recurrence: a study of tumour spread in the mesorectum distal to rectal cancer. Br J Surg 1995;82:1031–3.

    Google Scholar 

  121. Latulippe J, Potenti F, Weiss E, Nogueras J, Wexner S. Impact of colorectal board certification and volume on charges of colon and rectal surgery [meeting abstract]. Dis Colon Rectum 1998;41:A53.

    Google Scholar 

  122. Jones OM, Smeulders N, Wiseman O, Miller R. Lateral ligaments of the rectum: an anatomical study. Br J Surg 1999;86:487–9.

    Google Scholar 

  123. Moore J, Hewett P, Penfold JC,et al. Practice parameters for the management of colonic cancer: surgical issues. Recommendations of the Colorectal Surgical Society of Australia. Aust N Z J Surg 1999;69:415–21.

    Google Scholar 

  124. Zaheer S, Pemberton JH, Farouk R, Dozois RR, Wolff BG, Ilstrup D. Surgical treatment of adenocarcinoma of the rectum. Ann Surg 1998;227:800–11.

    Google Scholar 

  125. Bokey EL, Ojerskog B, Chapuis PH, Dent OF, Newland RC, Sinclair G. Local recurrence after curative excision of the rectum for cancer without adjuvant therapy: role of total anatomical dissection. Br J Surg 1999;86:1164–70.

    Google Scholar 

  126. O'Connell PR, Striker SJ, Metcalf AM, Pemberton JH, Kelly KA. Anal canal pressure and motility after ileoanal anastomosis. Surg Gynecol Obstet 1988;166:47–54.

    Google Scholar 

  127. Molloy RG, Moran KT, Coulter J, Waldron R, Kirwan WO. Mechanism of sphincter impairment following low anterior resection. Dis Colon Rectum 1992;35:462–4.

    Google Scholar 

  128. Otto IC, Ito K, Ye C,et al. Causes of rectal incontinence after sphincter-preserving operations for rectal cancer. Dis Colon Rectum 1996;39:1423–7.

    Google Scholar 

  129. Matzel KE, Stadelmaier U, Muehldorfer S, Hohenberger W. Continence after colorectal reconstruction following resection: impact of level of anastomosis. Int J Colorectal Dis 1997;12:82–7.

    Google Scholar 

  130. O'Connell PR. Mucosectomy in restorative proctocolectomy. Br J Surg 1991;78:129–30.

    Google Scholar 

  131. Ho YH, Tan M, Seow-Choen F. Prospective randomized controlled study of clinical function and anorectal physiology after low anterior resection: comparison of straight and colonic J pouch anastomoses. Br J Surg 1996;83:978–80.

    Google Scholar 

  132. Farouk R, Duthie GS, Lee PW, Monson JR. Endosonographic evidence of injury to the internal anal sphincter after low anterior resection: long-term follow-up. Dis Colon Rectum 1998;41:888–91.

    Google Scholar 

  133. Kollmorgen CF, Meagher AP, Wolff BG, Pemberton JH, Martenson JA, Ilstrup DM. The long-term effect of adjuvant postoperative chemoradiotherapy for rectal carcinoma on bowel function. Ann Surg 1994;220:676–82.

    Google Scholar 

  134. Iwamoto T, Nakahara S, Mibu R, Hotokezaka M, Nakano H, Tanaka M. Effect of radiotherapy on anorectal function in patients with cervical cancer. Dis Colon Rectum 1997;40:693–7.

    Google Scholar 

  135. Dahlberg M, Glimelius B, Graf W, Påhlman L. Preoperative irradiation affects functional results after surgery for rectal cancer: results from a randomized study. Dis Colon Rectum 1998;41:543–51.

    Google Scholar 

  136. Lundby L, Jensen VJ, Overgaard J, Laurberg S. Deleterious colorectal function after adjuvant postoperative radiotherapy for colorectal cancer: a randomized study [meeting abstract]. Dis Colon Rectum 1997;40:A34.

    Google Scholar 

  137. Williams NS, Price R. Johnston D. The long term effect of sphincter preserving operations for rectal carcinoma on function of anal sphincter in man. Br J Surg 1980;67:203–8.

    Google Scholar 

  138. McAnena OJ, Heald RJ, Lockhart-Mummery HE. Operative and functional results of total mesorectal excision with ultra-low anterior resection in the management of the carcinoma of the lower one-third of the rectum. Surg Gynecol Obstet 1990;170:517–21.

    Google Scholar 

  139. Pedersen IK, Hint K, Olsen J, Jensen P, Olsen J, Mortensen PE. Anorectal function after low anterior resection for carcinoma. Ann Surg 1986;204:133–5.

    Google Scholar 

  140. Paty PB, Enker WE, Cohen AM, Minsky BD, Friedlander-Klar H. Long-term functional results of coloanal anastomosis for rectal cancer. Am J Surg 1994;167:90–5.

    Google Scholar 

  141. Drake DB, Pemberton JH, Beart RW Jr, Dozois R, Wolff BG. Coloanal anastomosis in the management of benign and malignant rectal disease. Ann Surg 1988;206:600–5.

    Google Scholar 

  142. Lane RH, Parks AG. Functional of the anal sphincter following colo-anal anastomosis. Br J Surg 1977;64:596–9.

    Google Scholar 

  143. Keighley MR, Matheson D. Functional results of rectal excision and endoanal anastomosis. Br J Surg 1980;67:757–61.

    Google Scholar 

  144. Lewis WG, Holdsworth PJ, Stephenson BM, Finan PJ, Johnston D. Role of the rectum in the physiological and clinical results of coloanal and colorectal anastomosis after anterior resection for rectal carcinoma. Br J Surg 1992;79:1082–6.

    Google Scholar 

  145. Lazorthes F, Fages P, Chiotasso P, Lemozy J, Bloom E. Resection of the rectum with construction of a colonic reservoir and coloanal anastomosis for carcinoma of the rectum. Br J Surg 1986;73:136–8.

    Google Scholar 

  146. Yamana T, Oya M, Komatsu J, Takase Y, Mikuni N, Ishikawa H. Preoperative anal sphincter high pressure zone, maximum tolerable volume, and anal mucosal electrosensitivity predict early postoperative defecatory function after low anterior resection for rectal cancer. Dis Colon Rectum 1999;42:1145–51.

    Google Scholar 

  147. Nicholls RJ, Dubowski DZ, Donaldson DR. Comparison of colon reservoir and straight colon anal reconstruction after rectal excision. Br J Surg 1988;75:318–20.

    Google Scholar 

  148. Parc R, Tiret E, Frileux P, Moscowski E, Loygue J. Resection and coloanal anastomosis with colonic reservoir for rectal carcinoma. Br J Surg 1986;73:139–41.

    Google Scholar 

  149. Cavaliere F, Pemberton JH, Cosimelli M, Fazio VW, Beart RW Jr. Coloanal anastomosis for rectal cancer. Long-term results at the Mayo and Cleveland Clinics. Dis Colon Rectum 1995;38:807–12.

    Google Scholar 

  150. Vernava AM III, Robbins PL, Brabbee GW. Restorative resection: coloanal anastomosis for benign and malignant disease. Dis Colon Rectum 1989;32:690–3.

    Google Scholar 

  151. Seow-Choen F, Goh HS. Prospective randomized trial comparing J colonic pouch-anal anastomosis and straight coloanal reconstruction. Br J Surg 1995;82:608–10.

    Google Scholar 

  152. Hallböök O, Johansson K, Sjödahl R. Laser Doppler blood flow measurement in rectal resection for carcinoma—comparison between the straight and colonic J pouch reconstruction. Br J Surg 1996;83:389–92.

    Google Scholar 

  153. Joo JS, Latulippe JF, Alabaz O, Weiss EG, Nogueras JJ, Wexner SD. Long-term functional evaluation of straight coloanal anastomosis and colonic J-pouch: is the functional superiority of colon J-pouch sustained? Dis Colon Rectum 1998;41:740–6.

    Google Scholar 

  154. Hallböök O, Nyström PO, Sjödahl R. Physiologic characteristics of straight and colonic J-pouch anastomoses after rectal excision for cancer. Dis Colon Rectum 1997;40:332–8.

    Google Scholar 

  155. Kusunoki M, Shoji Y, Yanagi H,et al. Function after ano-abdominal resection and colonic J pouch anal anastomosis. Br J Surg 1991;78:1434–8.

    Google Scholar 

  156. Ortiz H, De Miguel M, Armendariz P, Rodriguez J, Chocarro C. Coloanal anastomosis: are functional results better with a pouch? Dis Colon Rectum 1995;38:375–7.

    Google Scholar 

  157. Rouanet P, Fabre JM, Dubois JB,et al. Conservative surgery for low rectal carcinoma after high-dose radiation. Functional and oncological results. Ann Surg 1995;221:67–73.

    Google Scholar 

  158. Wang JY, You YT, Chen HH, Chiang JM, Yeh CY, Tang R. Stapled colonic J-pouch anal anastomosis without a diverting colostomy for rectal cancer. Dis Colon Rectum 1997;40:30–4.

    Google Scholar 

  159. Hida JI, Yasutomi M, Fujimoto K,et al. Functional outcome after low anterior resection with low anastomosis for rectal cancer using the colonic J-pouch: prospective randomized study for determination of optimum pouch size. Dis Colon Rectum 1996;39:986–91.

    Google Scholar 

  160. Hida JI, Yasutomi M, Maruyama T, Tokoro T, Wakano T, Uchida T. Enlargement of colonic pouch after proctectomy and coloanal anastomosis: potential cause for evacuation difficulty. Dis Colon Rectum 1999;42:1181–8.

    Google Scholar 

  161. Banerjee AK, Parc R. Prediction of optimum dimensions of colonic pouch reservoir. Dis Colon Rectum 1996;39:1293–5.

    Google Scholar 

  162. Berger A, Tiret E, Parc R,et al. Excision of the rectum with colonic J-pouch anal anastomosis for adenocarcinoma of the low and mid rectum. World J Surg 1992;16:470–7.

    Google Scholar 

  163. Lazorthes F, Gamagami R, Chiotasso P, Istvan G, Muhammad S. Prospective, randomized study comparing clinical results between small and large colonic J-pouch following coloanal anastomosis. Dis Colon Rectum 1997;40:1409–13.

    Google Scholar 

  164. Ramirez JM, Mortensen NJ, Takeuchi N, Smilgin Humphreys MM. Colonic J-pouch rectal reconstruction is it really a neorectum? Dis Colon Rectum 1996;39:1286–8.

    Google Scholar 

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This study was supported in part by a generous educational grant from the Eleanor Naylor Dana Trust Fund.

Presented as the Sixth Annual David G. Jagelman, M.D., Memorial Oration at the 20th Annual Turnbull Symposium, Cleveland Clinic Foundation, Ohio, Cleveland, Ohio, October 1 to 2, 1999.

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Wexner, S.D., Rotholtz, N.A. Surgeon influenced variables in resectional rectal cancer surgery. Dis Colon Rectum 43, 1606–1627 (2000). https://doi.org/10.1007/BF02236751

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