Long-term functional changes after low anterior resection for rectal cancer compared between a colonic J-pouch and a straight anastomosis.
OBJECTIVE
We prospectively compared changes in function between colonic J-pouch and straight anastomoses from 1 to 5 years after low anterior resection for rectal cancer.


METHODS
At 1, 3, and 5 years after surgery, functional outcome was compared between 48 patients with J-pouch reconstruction (J group) and 51 with straight anastomosis (S group), using a 17-item questionnaire (overall best, 0; overall worst, 26). Reservoir function was evaluated manovolumetrically.


RESULTS
At 5 years, patients with ultralow anastomoses (< or =4 cm from anal verge) had fewer bowel movements during day or night, and less urgency and soiling in the J than S group. At that time, patients with low anastomoses (5 to 8 cm above the verge), had fewer bowel movements at night and less urgency in the J than S group. Manovolumetric results were better in the J than S group for both anastomotic levels. Functional scores improved significantly over time for both anastomotic levels, especially in the S group. Mean scores with ultralow anastomoses were J-group, 5.6 at 1 year vs. 5.3 at 3 years (P = 0.0304) vs. 3.7 at 5 years (P < 0.0001); and S group, 10.2 at 1 year vs. 9.6 at 3 years (P = 0.0063) vs. 7.3 at 5 years (P < 0.0001). Mean scores with low anastomoses were J group, 3.4 at 1 year vs. 3.1 at 3 years (P = 0.0052) vs. 2.1 at 5 years (P = 0.0003); and S group, 5.2 at 1 year vs. 3.8 at 3 years (P < 0.0001) vs. 2.7 at 5 years (P < 0.0001). Manovolumetric results improved overtime in both groups.


CONCLUSIONS
Functional outcome improved in the J and especially the S group over 5 years. However, function was better in the J than S group at all time points.
Hida
Jin-ichi
J
Department of Surgery, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama Osaka 589-8511, Japan. hida@surg.med.kindai.ac.jp
Yoshifuji
Takehito
T
Matsuzaki
Tomohiko
T
Hattori
Takashi
T
Ueda
Kazuki
K
Ishimaru
Eizaburou
E
Tokoro
Tadao
T
Yasutomi
Masayuki
M
Shiozaki
Hitoshi
H
Okuno
Kiyotaka
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery; D000714:Anastomosis, Surgical; D039021:Colonic Pouches; D003672:Defecation / Q000502:physiology; D005242:Fecal Incontinence / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000503:physiopathology / Q000601:surgery