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

Hida, Jin‐ichi; Yoshifuji, Takehito; Tokoro, Tadao; Inoue, Kiyohiko; Matsuzaki, Tomohiko; Okuno, Kiyotaka; Shiozaki, Hitoshi; Yasutomi, Masayuki

doi:10.1007/s10350-004-0654-4

Cited by 57 publications

(39 citation statements)

References 28 publications

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“…Hida et al [30] reported the long-term benefits of colonic J-pouch reconstruction suggesting that it improves reservoir function to a greater extent than straight anastomosis does, especially in patients in whom the anastomosis is less than 4 cm from the anal verge. In addition, Dennett et al [31] reported that colonic J-pouch is effective in very low rectal cancer surgery, causing apparent reduction in the incidence of anastomotic leaks and in bowel frequency.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Analysis of Clinical Factors Associated with Anal Function after Intersphincteric Resection for Very Low Rectal Cancer

Ito

Saitô

Sugito

et al. 2009

Diseases of the Colon &Amp; Rectum

139

104

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Background: Intersphincteric resection (ISR) has been used to avoid permanent colostomy in very low rectal cancer patients. This study aimed to assess the surgical safety and oncologic and functional outcomes of ISR. Methods: The records of 30 consecutive very low rectal cancer patients who underwent ISR without neoadjuvant therapy were retrospectively analyzed; survival and locoregional recurrence rates were calculated by the Kaplan-Meier method. Incontinence was assessed by a functionality questionnaire and the Wexner score. Results: The median distance between the distal margin of the dentate line was 10 mm. A total of 12, 4, and 14 patients underwent partial ISR, subtotal ISR, and total ISR, respectively. The mean distal resection margin was negative in all cases, and circumferential resection margin was positive in two cases. Morbidity was 33.3%: anastomotic stricture in seven patients, colonic J-pouch prolapse in two patients, and an anovaginal fistula in one patient. During the median, 56.2-month follow-up period, local, distant, and combined recurrences occurred in four, three, and two patients, respectively. The 5-year overall and disease-free survival rates were 76.5% and 68.4%, respectively. Local recurrence rates were 5.2% for the patients with Tis-T2 tumors as compared with 45.5% for those with T3 tumors (P = 0.008). The mean Wexner scores and stool frequencies, 12 months after stoma closure in 19 patients, were 11.5 and 6.6 per 24 h, respectively. Significant differences were not seen in the Wexner scores between partial ISR and subtotal/total ISR (11.8 ± 2.6 and 9.1 ± 5.6). Stool frequency (P = 0.02), urgency (P = 0.04), and fragmentation (P = 0.015) were worse in patients with anastomotic stricture than in those without; there was no symptom improvement in patients with anastomotic stricture. Conclusions: The anastomotic strictures in patients undergoing ISR may have negatively affected anal function. For total ISR patients, at least, informed consent stating the possibility of a permanent colostomy is necessary.

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Section: Surgical Proceduresmentioning

confidence: 99%

Analysis of Clinical Factors Associated with Anal Function after Intersphincteric Resection for Very Low Rectal Cancer

Ito

Saitô

Sugito

et al. 2009

Diseases of the Colon &Amp; Rectum

139

104

View full text Add to dashboard Cite

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“…Some studies [12,13] have reported that pouch reconstruction has an influence on the reduction of fragmentation in the shorter term but does not have effects on it in the longer term. However, since other studies [14,15] have reported that pouch reconstruction has a long-term effect on the reduction of fragmentation, it is speculated that this difference may be due to the difference in patients studied. Since it has been reported that a larger pouch may cause a sense of residual stool and defecation disorders, Hida et al [16] concluded that a pouch length of 5 cm was appropriate after comparing it with a pouch length of 10 cm.…”

Section: Discussionmentioning

confidence: 79%

Analysis of Autonomic Nerve Preservation and Pouch Reconstruction Influencing Fragmentation of Defecation after Sphincter-Preserving Surgery for Rectal Cancer

Katsumata

Sumi²,

Enomoto³

et al. 2010

Eur Surg Res

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Our questionnaire survey on defecation disorders after rectal cancer surgery revealed that 66.7% of postoperative patients were most annoyed with fragmentation of defecation. Therefore, we performed a change-over-time analysis on the relationship of fragmentation and factors including location of rectal cancer, surgical technique, anastomosis method, pouch reconstruction, extent of lymph node dissection, and degree of pelvic and colonic nerve preservation surrounding the superior mesenteric artery. The fragmentation decreased over time at the postoperative time points of 6 months, 2 and 5 years. A statistical analysis of factors influencing fragmentation revealed that location of cancer, reconstruction technique, anastomosis method and degree of pelvic nerve preservation were significant factors for the entire patient population and that colonic nerve preservation was a significant factor 5 years after surgery. Analysis of patients with lower rectal cancer only showed that in addition to surgical technique and anastomosis method, pouch reconstruction was effective and autonomic nerve preservation was effective 5 years after surgery. As a result, when the anastomotic site was closer to the anus, the frequency of fragmentation increased; we concluded that pouch reconstruction was an effective surgical technique and colonic nerve preservation was effective in the longer term.

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“…One study with a follow up period of 5 years showed a significantly less SF and imperative urge to defecate in the pouch group compared with straight colorectal anastomosis (52). In a retrospective study (45) with a follow-up of 5 years, imperative urge to defecate was less frequent in the pouch group compared with patients without a pouch.…”

Section: Clinical Long-term Resultsmentioning

confidence: 97%

“…In numerous controlled studies volumetric parameters of reservoir function, such as MTV, SV and compliance, were examined. In 13 out of 16 studies a significantly higher MTV was measured in the pouch group compared with the group without a pouch ( 5,32, 43,52,54,64,69,82,86,102,118,122,123,160,162). In most studies the patients were examined one year post-operatively.…”

Section: Colon J Pouch (Cjp)mentioning

confidence: 99%

Causes and Prevention of Functional Disturbances Following Low Anterior Resection for Rectal Cancer

Gross¹

2011

Rectal Cancer - A Multidisciplinary Approach to Management

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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

Abstract: 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.

Cited by 57 publications

References 28 publications

Analysis of Clinical Factors Associated with Anal Function after Intersphincteric Resection for Very Low Rectal Cancer

Analysis of Clinical Factors Associated with Anal Function after Intersphincteric Resection for Very Low Rectal Cancer

Analysis of Autonomic Nerve Preservation and Pouch Reconstruction Influencing Fragmentation of Defecation after Sphincter-Preserving Surgery for Rectal Cancer

Causes and Prevention of Functional Disturbances Following Low Anterior Resection for Rectal Cancer

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