title: A randomized multicenter trial to compare long-term functional outcome, quality of life, and complications of surgical procedures for low rectal cancers.
abstract: BACKGROUND
  Colonic pouches have been used for 20 years to provide reservoir function after reconstructive proctectomy for rectal cancer. More recently coloplasty has been advocated as an alternative to a colonic pouch. However there have been no long-term randomized, controlled trials to compare functional outcomes of coloplasty, colonic J-Pouch (JP), or a straight anastomosis (SA) after the treatment of low rectal cancer.
  
  
  OBJECTIVE
  : To compare the complications, long-term functional outcome, and quality of life (QOL) of patients undergoing a coloplasty, JP, or an SA in reconstruction of the lower gastrointestinal tract after proctectomy for low rectal cancer.
  
  
  METHODS
  A multicenter study enrolled patients with low rectal cancer, who were randomized intraoperatively to coloplasty (CP-1) or SA if JP was not feasible, or JP or coloplasty (CP-2) if a JP was feasible. Patients were followed for 24 months with SF-36 surveys to evaluate the QOL. Bowel function was measured quantitatively and using Fecal Incontinence Severity Index (FISI). Urinary function and sexual function were also assessed.
  
  
  RESULTS
  Three hundred sixty-four patients were randomized. All patients were evaluated for complications and recurrence. Mean age was 60 +/-12 years, 71% were male. Twenty-three (7.4%) died within 24 months of surgery. No significant difference was observed in the complications among the 4 groups. Two hundred ninety-seven of 364 were evaluated for functional outcome at 24 months. There was no difference in bowel function between the CP-1 and SA groups. JP patients had fewer bowel movements, less clustering, used fewer pads and had a lower FISI than the CP-2 group. Other parameters were not statistically different. QOL scores at 24 months were similar for each of the 4 groups.
  
  
  CONCLUSIONS
  In patients undergoing a restorative resection for low rectal cancer, a colonic JP offers significant advantages in function over an SA or a coloplasty. In patients who cannot have a pouch, coloplasty seems not to improve the bowel function of patients over that with an SA.
authors: Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors: Victor W
authors: VW
authors: Fazio
authors: Massarat
authors: M
authors: Zutshi
authors: Feza H
authors: FH
authors: Remzi
authors: Yann
authors: Y
authors: Parc
authors: Reinhard
authors: R
authors: Ruppert
authors: Alois
authors: A
authors: Fürst
authors: James
authors: J
authors: Celebrezze
authors: Susan
authors: S
authors: Galanduik
authors: Guy
authors: G
authors: Orangio
authors: Neil
authors: N
authors: Hyman
authors: Leslie
authors: L
authors: Bokey
authors: Emmanuel
authors: E
authors: Tiret
authors: Boris
authors: B
authors: Kirchdorfer
authors: David
authors: D
authors: Medich
authors: Marcus
authors: M
authors: Tietze
authors: Tracy
authors: T
authors: Hull
authors: Jeff
authors: J
authors: Hammel
mesh_terms: D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D039021:Colonic Pouches / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
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