Abstract
PURPOSE: Functional outcome after low anterior resection with ultralow coloanal anastomosis for rectal cancer is improved by construction of a colonic J-pouch vs. straight anastomosis. Optimum size of this pouch has yet to be determined. Therefore, we initiated a prospective, randomized trial using 5-cm and 10-cm pouches to determine this size. METHODS: Patients with tumors 5 to 10 cm from the anal verge were included in the study. Before a low anterior resection anastomosis was performed, patients were randomized to either a 5-cm J-pouch group (5-J group) or a 10-cm J-pouch group (10-J group). Functional assessments were performed one year postoperatively. Clinical functions were evaluated using a functional scoring system. Physiologic functions, such as sphincter and reservoir function, were evaluated by anorectal manometry and evacuation function by the balloon expulsion and saline evacuation tests. RESULTS: Forty patients among 43 randomized patients were assessed for functional outcome one year postoperatively (5-J group, n=20; 10-J group, n=20). The functional score was similar for the two groups, although reservoir function in the 5-J group was significantly less than in the 10-J group. Sphincter function was similar between the two groups. Evacuation function in the 5-J group was significantly superior to that in the 10-J group. CONCLUSIONS: The 5-cm J-pouch conferred adequate reservoir function without compromising evacuation.
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Paty PB, Enker WE, Cohen AM, Lauwers GY. Treatment of rectal cancer by low anterior resection with coloanal anastomosis. Ann Surg 1994;219:365–73.
Sun WM, Read NW, Katsinelos P, Donnelly TC, Shorthouse AJ. Anorectal function after restorative proctocolectomy and low anterior resection with coloanal anastomosis. Br J Surg 1994;81:280–4.
Lazorthes F, Fages P, Chiotasso P, Lemozy J, Bloom E. Resection of the rectum with construction of a colonic reservoir and colo-anal anastomosis for carcinoma of the rectum. Br J Surg 1986;73:136–8.
Parc P, Tiret E, Frileux P, Moszkowski E, Loygue J. Resection and colo-anal anastomosis with colonic reservoir for rectal carcinoma. Br J Surg 1986;73:139–41.
Drake DB, Pemberton JH, Beart RW Jr, Dozois RR, Wolff BG. Coloanal anastomosis in the management of benign and malignant rectal disease. Ann Surg 1987;206:600–5.
Nicholls RJ, Lubowski DZ, Donaldson DR. Comparison of colonic reservoir and straight colo-anal reconstruction after rectal excision. Br J Surg 1988;75:318–20.
Kusunoki M, Shoji Y, Yanagi H,et al. Function after anoabdominal rectal resection and colonic J pouch-anal anastomosis. Br J Surg 1991;78:1434–8.
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.
Pélissier EP, Blum D, Bachour A, Bosset JF. Functional results of coloanal anastomosis with reservoir. Dis Colon Rectum 1992;35:843–6.
Leo E, Belli F, Baldini MT,et al. New perspective in the treatment of low rectal cancer: total rectal resection and coloendoanal anastomosis. Dis Colon Rectum 1994;37(Suppl):S62–8.
Mortensen NJ, Ramirez JM, Takeuchi N, Smilgin Humphreys MM. Colonic J pouch-anal anastomosis after rectal excision for carcinoma: functional outcome. Br J Surg 1995;82:611–3.
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.
Oritz H, De Miguel M, Armendáriz P, Rodriguez J, Chocarro C. Coloanal anastomosis: are functional results better with a pouch? Dis Colon Rectum 1995;38:375–7.
UICC. TNM classification of malignant tumors. 4th ed (2nd revision). Tokyo: Springer-Verlag, 1992;52–5.
Yasutomi M, Hida J. Functional results after low anterior resection for rectal cancer. In: Hojo K, ed. Archives of pelvic surgery for cancer. Tokyo: The Japanese Ministry of Health and Welfare, 1994;10–2.
Japanese Research Society for Cancer of the Colon and Rectum. Multi-Institutional Registry of Large Bowel Cancer in Japan. 9 vols. Tochigi, Japan: Japanese Research Society for Cancer of the Colon and Rectum, 1994;24–5.
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Supported, in part, by a Grant-in-Aid for Cancer Research from the Japanese Ministry of Health and Welfare and a Grant-in-Aid for Scientific Research from the Japanese Ministry of Education, Culture, and Science.
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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. Dis Colon Rectum 39, 986–991 (1996). https://doi.org/10.1007/BF02054686
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DOI: https://doi.org/10.1007/BF02054686