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Annals of Surgical Oncology

, Volume 14, Issue 7, pp 1972–1979 | Cite as

Comparison of Functional and Surgical Outcomes of Laparoscopic-Assisted Colonic J-Pouch Versus Straight Reconstruction After Total Mesorectal Excision for Lower Rectal Cancer

  • Jin-Tung LiangEmail author
  • Hong-Shiee Lai
  • Po-Huang Lee
  • Kuo-Chin Huang
Gastrointestinal Oncology Multimedia

Abstract

Background

To compare the functional and surgical outcomes of colonic J-pouch and straight anastomosis in the context that both reconstruction procedures were performed laparoscopically.

Methods

The present study was a randomized prospective clinical trial. Patients with lower rectal cancer requiring laparoscopic total mesorectal excision were equally randomized to either laparoscopic-assisted colonic J-pouch reconstruction or laparoscopic straight end-to-end anastomosis. The techniques of the laparoscopic-assisted colonic J-pouch reconstruction are shown in the attached video. The primary end point was the comparison of functional results in both reconstruction methods. The secondary end points included the safety (surgical morbidity and mortality), surgical efficiency, and postoperative recovery.

Results

A total of 48 patients were recruited within 2-year periods, in consideration of statistical power of 90% for comparison. There was no marked difference between patient groups undergoing colonic J-pouch surgery (n = 24) and straight anastomosis (n = 24) in various demographic and clinicopathogic parameters. The anorectal function of patients by colonic J-pouch were better than those by straight anastomosis in 3 months after operation, as evaluated by stool frequency (mean ± standard deviation: 4.0 ± 2.0 vs. 7.0 ± 2.4 times/day, P < .001); use of antidiarrheal agents (29.2% [n = 7] vs. 75.0% [n = 18], P = .004); and perineal irritation (45.8% [n = 11] vs. 79.2% [n = 19], P = .037). Because of the relatively better bowel function in immediate postoperative period, patients by colonic J-pouch reconstruction were less disabled after surgery and had quicker return to partial activity (P = .039), full activity (P < .001), and work (P < .001). Both reconstruction methods were performed with similar amounts of blood loss, complication rates, and postoperative recovery. However, the operation time was significantly longer in the colonic J-pouch group (274.4 ± 34.0 vs. 202.0 ± 28.0 minutes, P < .001).

Conclusions

Because laparoscopic-assisted creation of a colonic J-pouch achieved better short-term functional results of the anorectum and did not increase surgical morbidity, as compared with laparoscopic straight anastomosis, this reconstruction procedure could be recommended to patients with lower rectal cancer requiring laparoscopic total mesorectal excision.

Keywords

Laparoscopic surgery Colonic J-pouch Rectal cancer Total mesorectal excision 

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Notes

Acknowledgment

Supported by a grant from National Taiwan University Hospital (96-S557).

Supplementary material

Supplementary material

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Copyright information

© Society of Surgical Oncology 2007

Authors and Affiliations

  • Jin-Tung Liang
    • 1
    Email author
  • Hong-Shiee Lai
    • 1
  • Po-Huang Lee
    • 1
  • Kuo-Chin Huang
    • 2
  1. 1.Department of SurgeryNational Taiwan University Hospital and College of MedicineTaipeiTaiwan, Republic of China
  2. 2.Department of Family MedicineNational Taiwan University Hospital and College of MedicineTaipeiTaiwan, Republic of China

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