Analysis of autonomic nerve preservation and pouch reconstruction influencing fragmentation of defecation after sphincter-preserving surgery for rectal cancer.
Our questionnaire survey on defecation disorders after rectal cancer surgery revealed that 66.7% of postoperative patients were most annoyed with fragmentation of defecation. Therefore, we performed a change-over-time analysis on the relationship of fragmentation and factors including location of rectal cancer, surgical technique, anastomosis method, pouch reconstruction, extent of lymph node dissection, and degree of pelvic and colonic nerve preservation surrounding the superior mesenteric artery. The fragmentation decreased over time at the postoperative time points of 6 months, 2 and 5 years. A statistical analysis of factors influencing fragmentation revealed that location of cancer, reconstruction technique, anastomosis method and degree of pelvic nerve preservation were significant factors for the entire patient population and that colonic nerve preservation was a significant factor 5 years after surgery. Analysis of patients with lower rectal cancer only showed that in addition to surgical technique and anastomosis method, pouch reconstruction was effective and autonomic nerve preservation was effective 5 years after surgery. As a result, when the anastomotic site was closer to the anus, the frequency of fragmentation increased; we concluded that pouch reconstruction was an effective surgical technique and colonic nerve preservation was effective in the longer term.
Department of Surgery, Tokyo Medical University, Tokyo, Japan. kenji.katsu @ jcom.home.ne.jp
K
K
Katsumata
T
T
Sumi
M
M
Enomoto
Y
Y
Mori
T
T
Aoki
D000368:Aged; D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery; D000714:Anastomosis, Surgical / Q000379:methods; D017776:Autonomic Pathways / Q000503:physiopathology / Q000601:surgery*; D003106:Colon / Q000294:innervation; D003672:Defecation / Q000502:physiology*; D005242:Fecal Incontinence / Q000503:physiopathology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control; D012004:Rectal Neoplasms / Q000503:physiopathology* / Q000601:surgery*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors