Denervation of the Neorectum as a Potential Cause of Defecatory Disorder Following Low Anterior Resection for Rectal Cancer

Koda, Keiji; Saitô, Norio; Seike, Kazuhiro; Shimizu, Kimio; Kosugi, Chihiro; Miyazaki, Masaru

doi:10.1007/s10350-004-0814-6

Cited by 85 publications

(72 citation statements)

References 16 publications

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“…there is evidence that patients with major laRs have an increased postprandial response with a significant increase in pressure in the neorectum after a meal in comparison with patients without laRs 7 and that colonic transit time is shorter in patients after rectal resection. 8 this was confirmed by the observations that the motility of the neorectum following low anterior resection appears degraded by intraoperative maneuvers that cause denervation of the remnant sigmoid colon, 9 and surgical denervation of the left colon results in a significant increase in motility. 10 Colonic manometric analysis of the tracing in patients with laRs revealed a reduction of contractile segmental activity and many more high-amplitude propagated contractions than which occur in healthy subjects.…”

Section: Physiopathological Considerationssupporting

confidence: 50%

Low Anterior Resection Syndrome

Martellucci

2016

Diseases of the Colon &Amp; Rectum

130

112

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f or almost 100 years abdominoperineal excision has been the standard treatment of choice for rectal cancer. however, as miles said, "the operation is a severe one. i do not think that it should be performed on those over 60 years of age; of 10 such cases all died. With regard to the remainder, of whom there were 36, 8 died from the effects of the operation, 4 have had recurrence, 2 died of intercurrent disease, while 22 are alive and well after periods varying from six months to six years." 1 the conviction that the quality of life for patients with a colostomy after abdominoperineal excision was poorer than for patients undergoing an operation with a sphincterpreserving technique has meant that, over the past 20 years, the anterior resection with preservation of the sphincter function has become the preferred treatment for rectal cancers, with the exception of those cancers very close to the anal sphincter.to date, also thanks to the multimodal treatment of rectal cancer, sphincter-preserving surgery with the restoration of bowel continuity to avoid a permanent colostomy is feasible in up to 80% of these patients. however, patients having sphincter-preserving operations may experience symptoms affecting their quality of life that are different from stoma patients and the question of whether the quality of life of people after anterior resection is superior to that of people after abdominoperineal excision/hartmann operation has yet to be answered.in fact, up to 80% of patients undergoing a low or very low anterior resection will experience postoperatively a constellation of symptoms including fecal urgency, frequent bowel movements, bowel fragmentation, emptying difficulties and incontinence, increased gas, collectively referred to as the low anterior resection syndrome (laRs).even if most of the functional impairments are clinically recovered by 6 to 12 months after the operation, longterm studies are now reporting the presence of adverse symptoms up to 15 years after resection. these long-term results suggest that after about 12 months, the symptoms of anterior resection syndrome are the result of permanent changes rather than short-lived neorectal irritability in the postoperative period. 2 Bowel dysfunction is a major problem with an immense impact on quality of life following sphincter-preserving resection, and the quality of life of patients who have had rectal cancer is closely associated with the severity of the laRs. 3 impaired bowel function is usually provoked by the variable association of colonic dysmotility, neorectal reservoir dysfunction, and anal sphincter or pelvic nerves damage.there are currently no specific treatments for anterior resection syndrome. management is empirical and symptom based, using existing therapies for fecal incontinence, fecal urgency, and rectal evacuatory disorders. moreover, rectal cancer specialists do not have a very thorough understanding of which bowel dysfunction symptoms truly matter to the patient after sphincter-preserving treatment, or how these symptoms affe...

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Section: Physiopathological Considerationssupporting

confidence: 50%

Low Anterior Resection Syndrome

Martellucci

2016

Diseases of the Colon &Amp; Rectum

130

112

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“…25 Damage to the autonomic innervation of the internal anal sphincter (IAS) mechanism and the neorectum might be the main potential cause of postoperative anorectal abnormalities. 1,26 Several studies have demonstrated an abolishment of the RAIR in all patients after the operation. 8,22,27 The development of preaortic autonomic nerves preservation TME in the treatment of rectal cancer has been associated with the signifi cant improvement of quality of life.…”

Section: Discussionmentioning

confidence: 99%

Prospective Evaluation of the Defecatory Functional Results in Patients Following Aorto-Aortic Reconstruction Surgery for an Abdominal Aortic Aneurysm

et al. 2007

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“…2 Correlation of evacuation difficulty (sensation of incomplete evacuation) and pouch size (CJP patients from studies with intermediate-term follow-up) anterior resection, the nerve supply running with the inferior mesenteric artery is removed, and parasympathetic supply from the pelvic plexus is also destroyed [79]. Koda and co-workers [79] found that a substantial portion of patients with rectal resection had a loss of propagated contractions in the colon and minor spastic contractions in the neorectum, which was interpreted as a result of denervation. Defecation disorders in terms of multiple evacuations were significantly correlated with the loss of propagated contractions in the colon and the presence of spastic minor contractions in the neorectum.…”

Section: Discussionmentioning

confidence: 99%