Effect of Anastomosis Level on Continence Performance and Quality of Life after Colonic J-pouch Reconstruction

Abstract

Total mesorectal excision (TME) has become the recommended method for treatment of cancer in the middle or lower third of the rectum. Thus very low anastomoses are necessary to preserve continence, and pouch reconstruction is favored. It is unclear whether the level of anastomosis is important for continence and quality of life in colonic J-pouch reconstruction. In this investigation all patients were included who underwent curative elective anterior continuity resection with colorectal or coloanal J-pouch reconstruction for primary rectal cancer between January 2001 and December 2004. Exclusion criteria were distant metastases and any signs of recurrence at the time of investigation. Evaluation of continence performance by Wexner and Holschneider questionnaire and quality of life using the QLQ-C30 and QLQ-CR38 (EORTC) questionnaires was done 220 +/- 38 days after closure of the protective Ileostomy, which was performed 106 +/- 48 days after primary intervention. Fifty-two patients (79%) were analyzed. Colopouch rectal anastomosis was performed in eighteen cases and colopouch anal anastomosis in thirty-four cases. Fifty percent of the patients in both groups were continent for solid stool. Patients with a colopouch anal anastomosis had a significantly higher rate of incontinence for liquid stool, however. They took stool-regulating medicine more frequently and complained of fecal soiling and a restricted quality of life. Patients with a colopouch anal anastomosis had a significantly lower score on the most important points of the QLQ-C30 (emotional functioning, social functioning, pain, and quality of life). The same applied to the QLQ-CR38 for body image and problems with defecation. The quality of life of patients with a colopouch anal anastomosis was still considered acceptable compared with reference data for the normal healthy population, however. Both continence and quality of life are substantially affected by the level of the anastomosis after colonic pouch reconstruction. This suggests preservation of a small part of the rectum when oncologically feasible and performing a colopouch rectal anastomosis.

Clinical Outcome After Rectal Replacement With Side-to-End, Colon-J-Pouch, or Straight Colorectal Anastomosis Following Total Mesorectal Excision

“…These findings are in line with published reports investigating the functional impact of anastomotic levels following CJP anastomoses. 38 Limitations of our study should be acknowledged. In particular, an important limitation might be represented by the use of relatively rarely utilized composite evacuation and incontinence scores.…”

“…1). The 4 university centers, 4 referral centers, and 7 peripheral clinics contributed 104 (5-40), 152 (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44), and 80 (1-33) patients, respectively. One hundred twelve patients were randomized to each treatment arm.…”

Treatment options to improve anorectal function following rectal resection: a systematic review

“…Furthermore, post-treatment function depends on the surgical procedure, the use of adjuvant treatment, level of anastomosis, presence of an intestinal reservoir, the need for a temporary stoma and the suture technique [41][42][43]. For this reason the six studies of restorative proctocolectomy with ileal reservoir were not included in the present study [44][45][46][47][48][49] and greater attention was given to function during the early period of recovery and in the long-term follow-up [50].…”

A meta-analysis comparing side to end with colonic J-pouch formation after anterior resection for rectal cancer

“…Transverse coloplasty has been shown by some studies to be inferior to J-pouch [7]. J-pouches have gained popularity since 1980 as they provide better QOL and functional outcome compared with straight anastomoses [8]. STEA or Baker type anastomosis has been used since 1966 [9] and has reasonable functional results [10] and operative outcomes when compared with straight anastomosis [11].…”