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Comparison of Long-Term Functional Results of Colonic J-Pouch and Straight Anastomosis After Low Anterior Resection for Rectal Cancer: A Five-Year Follow-Up

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Diseases of the Colon & Rectum

PURPOSE

Few reports on the long-term functional outcome of colonic J-pouch reconstruction have been published, and data comparing J-pouch and straight reconstruction are contradictory. This prospective study compares the functional outcome of colonic J-pouch and straight anastomosis five years after low anterior resection for rectal cancer.

METHODS

Functional outcome was compared in 46 patients with J-pouch reconstruction (J-group) and 48 patients with straight anastomosis (S-group). Clinical status was evaluated with a 17-item questionnaire inquiring about different aspects of bowel function. Reservoir function was evaluated by manovolumetry. The Fisher’s exact test and Wilcoxon’s rank-sum test were used to compare categoric and quantitative data, respectively.

RESULTS

Among patients with an ultralow anastomosis (≤4 cm from the anal verge), the number of bowel movements during the day (≥5, 4.3 vs. 29.2 percent; P = 0.028) and at night (>1/week, 4.3 vs. 33.3 percent; P = 0.013) and urgency (4.3 vs. 33.3 percent; P = 0.013) and soiling (21.7 vs. 50.0 percent; P = 0.043) were less in the J-group than in the S-group. Among patients with a low anastomosis (5 to 8 cm from the verge), patients in the J-group had fewer bowel movements at night (>1/week, 0 vs. 20.8 percent; P = 0.028) and less urgency (0 vs. 20.8 percent; P = 0.028). Reservoir function was better in the J-group than in the S-group in both the ultralow (maximum tolerable volume (mean), 101.7 vs. 76.3 ml; P = 0.004; threshold volume (mean), 46.5 vs. 30.4 ml; P < 0.001; compliance (mean), 4.9 vs. 2.5 ml/cm H2O; P < 0.001) and low-anastomosis (maximum tolerable volume, 120.4 vs. 97.9 ml; P < 0.001; threshold volume, 58.3 vs. 40.8 ml; P < 0.001; compliance, 5.2 vs. 3.1 ml/cm H2O; P < 0.001) groups.

CONCLUSIONS

J-pouch reconstruction increased reservoir function and provided better functional outcome than straight anastomosis, even five years after surgery, especially in patients whose anastomosis is less than 4 cm from the anal verge.

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Authors and Affiliations

  1. First Department of Surgery, Kinki University School of Medicine, Osaka, Japan

    Jin-ichi Hida M.D., Takehito Yoshifuji M.D., Tadao Tokoro M.D., Kiyohiko Inoue M.D., Tomohiko Matsuzaki M.D., Kiyotaka Okuno M.D., Hitoshi Shiozaki M.D. & Masayuki Yasutomi M.D.

Authors
  1. Jin-ichi Hida M.D.
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  2. Takehito Yoshifuji M.D.
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  3. Tadao Tokoro M.D.
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  4. Kiyohiko Inoue M.D.
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  5. Tomohiko Matsuzaki M.D.
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  6. Kiyotaka Okuno M.D.
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  7. Hitoshi Shiozaki M.D.
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  8. Masayuki Yasutomi M.D.
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Correspondence to Jin-ichi Hida M.D..

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Supported in part by a grant-in-aid for scientific research from the Japanese Ministry of Education, Culture, Sports, Science and Technology, and a grant for cancer research from the Osaka Cancer Foundation.

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Hida, Ji., Yoshifuji, T., Tokoro, T. et al. Comparison of Long-Term Functional Results of Colonic J-Pouch and Straight Anastomosis After Low Anterior Resection for Rectal Cancer: A Five-Year Follow-Up. Dis Colon Rectum 47, 1578–1585 (2004). https://doi.org/10.1007/s10350-004-0654-4

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  • DOI: https://doi.org/10.1007/s10350-004-0654-4

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