Abstract
Since 1978, 41 patients (12 percent of all restorative operations) have undergone peranal coloanal reconstruction following anterior resection (LAR) for cancers of the midrectum. Twenty-seven patients (66 percent) were men and 14 patients (34 percent) were women (mean, 58.8 years). The mean distance of the primary tumor from the anal verge was 6.7 cm and 50 percent of the primary tumors were considered highly mobile. In 29 patients, a hand-sewn anastomosis was performed between the colon and the dentate line. In the 12 most recent patients, the anastomosis was performed using a circular stapling instrument. A diverting colostomy should be employed in all cases and is closed approximately three months later. There has been no operative mortality. Morbidity included anastomotic separation (two patients), minor anastomotic defects (three patients), pelvic sepsis (two patients), and bacteremia of unknown origin (two patients). Where fecal diversion was employed, there were no instances of anastomotic leak. Two patients with hemorrhage were returned to the operating room. Thirty-seven of the 41 patients underwent curative resections. Thirty-three percent of the patients had Dukes' C lesions. With a median follow-up of 31 months for the curative resections, 73 percent remain free of disease. Sixty-four percent of evaluable patients have either excellent or good anorectal function nine to 12 months after colostomy closure. Of 26 operations performed by one surgeon, 22 patients (85 percent) are currently evaluable. Nineteen (86 percent) of the 22 have normal or near-normal bowel function. Four guidelines for performing a functionally successful operation are presented. Coloanal reconstruction following LAR, were pull-through operations were previously required, is an excellent sphincter-preserving operation. The functional results one year after the operation are gratifying, with the majority of patients leading an active life with normal bowel function.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Parks AG. Transanal technique in low rectal anastomosis. Proc R Soc Med 1972;65:975–6.
Bacon HE. Evolution of sphincter muscle preservation and the re-establishment of continuity in the operative treatment of rectal and sigmoidal cancer. Surg Gynecol Obstet 1945;81:113–27.
Babcock WW. Experiences with resection of the colon and the elimination of colostomy. Am J Surg 1939;46:186–203.
Turnbull RB Jr, Cuthbertson AM. Abdominorectal pull-through resection for cancer and for Hirschsprung's disease. Cleve Clin Q 1961;28:109–15.
Cutait DE, Figlioni FJ. A new method of colorectal anastomosis in abdominoperineal resection. Dis Colon Rectum 1961;4:335–42.
Parks AG, Lane RHS. Normal and disordered function of the rectum and pelvic floor. In: Thomson JP, Nicholls RJ, Williams CB, eds. Colorectal disease. London: W Heineman Medical Books, Ltd, 1981:102–8.
Lane RH, Parks AG. Function of the anal sphincters following colo-anal anastomosis. Br J Surg 1977;64:596–9.
Enker WE, Pilipshen SJ, Heilweil ML, et al. En bloc pelvic lymphadenectomy and sphincter preservation in the surgical management of rectal cancer (in press).
Goligher JC. Use of circular stapling gun with peranal insertion of anorectal purse-string suture for construction of very low colorectal or colo-anal anastomoses. Br J Surg 1979;66:501–4.
Enker WE. Coloanal reconstruction following low anterior resection for rectal cancer. Chicago, American College of Surgeons, Cine Clinics, 1984. The Davis & Geck Film Library, Danbury, Connecticut.
Pilipshen SJ, Heilweil M, Quan SH, Sternberg SS, Enker WE. Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer 1984;53:1354–62.
Stearns MW Jr. The choice among anterior resection, the pull-through and abdominoperineal resection of the rectum. 1974;34:969–71.
Kirwan WO, Turnbull RB Jr, Fazio VW, Weakley FL. Pull-through operation with delayed anastomosis for rectal cancer. Br J Surg 1978;65:695–8.
Killingback MK. Quoted by McDermott FT. Carcinoma of the rectum. In: Hughes ES, Cuthbertson AM, Killingback MK, eds. Colorectal surgery. Melbourne: Churchill Livingstone, 1983:377–9.
Mason AY. Transsphincteric surgery for low rectal cancer. Surg Tech Illus 1977;2:71–90.
Localio SA, Stahl WM. Simultaneous abdominotranssacral resection and anastomosis for midrectal cancer. Am J Surg 1969;117:282–9.
Keighley MR, Matheson D. Functional results of rectal excision and endo-anal anastomosis. Br J Surg 1980;67:757–61.
Rudd WW. The transanal anastomosis: a sphincter-saving operation with improved continence. Dis Colon Rectum 1979;22:102–5.
Parks AG, Percy JP. Resection and sutured colo-anal anastomosis for rectal carcinoma. Br J Surg 1982;69:301–4.
Nicholls RJ. Rectal cancer: anterior resection with per-anal coloanal anastomosis. The results in 76 patients treated by Sir Alan Parks. Bull Cancer (Paris) 1983;70:304–7.
Author information
Authors and Affiliations
Additional information
Supported in part by Grant # CA31545-02 and by The Ron Larak Memorial Cancer Research Fund.
Read at the meeting of The American Society of Colon and Rectal Surgeons, San Diego, California, May 5 to 10, 1985.
About this article
Cite this article
Enker, W.E., Stearns, M.W. & Janov, A.J. Peranal coloanal anastomosis following low anterior resection for rectal carcinoma. Dis Colon Rectum 28, 576–581 (1985). https://doi.org/10.1007/BF02554147
Issue Date:
DOI: https://doi.org/10.1007/BF02554147