title: Indications for colonic J-pouch reconstruction after anterior resection for rectal cancer: determining the optimum level of anastomosis.
abstract: OBJECTIVE
  Functional outcome after anterior resection for rectal cancer is improved by colonic J-pouch reconstruction compared with straight anastomosis. The indications for colonic J-pouch reconstruction have yet to be determined. Therefore, we attempted to determine the level at which J-pouch reconstruction provides an advantage over straight anastomosis.
  
  
  METHODS
  A total of 48 patients who underwent 5-cm colonic J-pouch reconstruction (J-pouch group) and 80 patients who underwent straight anastomosis (straight group) underwent functional assessment one year postoperatively.
  
  
  RESULTS
  The functional outcome in the J-pouch group was significantly better than that in the straight group when the distance of the anastomosis from the anal verge was less than 8 cm. The difference was particularly obvious when the level of the anastomosis was below 4 cm. However, functional outcome in the straight group when the anastomosis was between 9 and 12 cm from the anal verge was also satisfactory and did not differ from that in the J-pouch group when the anastomosis was between 5 and 8 cm from the anal verge.
  
  
  CONCLUSIONS
  Colonic J-pouch reconstruction is indicated when the distance of anastomosis from the anal verge is less than 8 cm, and it is essential when the distance is less than 4 cm.
authors.affiliation: First Department of Surgery, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Hida
authors.forename: M
authors.initials: M
authors.lastname: Yasutomi
authors.forename: T
authors.initials: T
authors.lastname: Maruyama
authors.forename: K
authors.initials: K
authors.lastname: Fujimoto
authors.forename: A
authors.initials: A
authors.lastname: Nakajima
authors.forename: T
authors.initials: T
authors.lastname: Uchida
authors.forename: T
authors.initials: T
authors.lastname: Wakano
authors.forename: T
authors.initials: T
authors.lastname: Tokoro
authors.forename: R
authors.initials: R
authors.lastname: Kubo
authors.forename: K
authors.initials: K
authors.lastname: Shindo
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D000075202:Contraindications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012004:Rectal Neoplasms / Q000601:surgery*; D016896:Treatment Outcome