A randomized multicenter trial to compare long-term functional outcome, quality of life, and complications of surgical procedures for low rectal cancers.
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.
Fazio
Victor W
VW
Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Zutshi
Massarat
M
Remzi
Feza H
FH
Parc
Yann
Y
Ruppert
Reinhard
R
Fürst
Alois
A
Celebrezze
James
J
Galanduik
Susan
S
Orangio
Guy
G
Hyman
Neil
N
Bokey
Leslie
L
Tiret
Emmanuel
E
Kirchdorfer
Boris
B
Medich
David
D
Tietze
Marcus
M
Hull
Tracy
T
Hammel
Jeff
J
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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