title: Functional results after TME: J-pouch vs straight coloanal anastomosis and role of neoadjuvant radiochemotherapy.
abstract: OBJECTIVE
  Purpose of this study was to evaluate short and long term functional outcomes after TME (total mesorectal excision) for rectal cancer. The role of straight anastomosis or colonic J-pouch reconstruction is investigated, as well as the impact of preoperative chemoradiotherapy is analyzed as a cause of the so called "anterior resection syndrome".
  
  
  METHODS
  We enrolled 40 patients (17 male and 23 female), in which a low anterior resection was performed: they were divided in four groups: A1 (Straight and no RCT), A2 (Straight and RCT), B1 (J-pouch and no RCT), B2 (J-pouch and RCT). Follow-up was performed six and twelve months after surgery, through a clinical questionnaire ( to assess: stool frequency, incomplete emptying, the presence of fecal leakage, urgency and incontinence ) and through anorectal manometry ( to assess rest pressure, squeeze pressure, max tolerated volume and compliance). Results were evaluated through T-Student and Chi-Squared test.
  
  
  RESULTS
  Six months after surgery, colonic J-pouch offers the best clinical and functional results, in both radiated and not radiated patients (except for incomplete emptying); in the straight group, however, there is an improvement of results after twelve months. Chemoradiation therapy is always associated with worse functional results.
  
  
  CONCLUSIONS
  RCT seems to invalidate J-pouch function in particular, in fact twelve months after surgery the difference between J-Pouch and Straight groups is not statistically different for most of the parameters.
  
  
  CONCLUSIONS
  J-pouch gives a real functional advantage for only six months after surgery, especially in patients treated with neoajuvant chemoradiation therapy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Luglio
authors.forename: Stefania
authors.initials: S
authors.lastname: Masone
authors.forename: Gennaro
authors.initials: G
authors.lastname: Quarto
authors.forename: Giacomo
authors.initials: G
authors.lastname: Benassai
authors.forename: Viviana
authors.initials: V
authors.lastname: Sollazzo
authors.forename: Rachele
authors.initials: R
authors.lastname: Tarquini
authors.forename: Valerio
authors.initials: V
authors.lastname: Celentano
authors.forename: Mariano
authors.initials: M
authors.lastname: Giglio
authors.forename: Luigi
authors.initials: L
authors.lastname: Bucci
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D059248:Chemoradiotherapy; D003106:Colon / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011446:Prospective Studies; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000628:therapy*