Resection For Low Rectal Cancer Research Articles

A meta-analysis comparing functional outcome following straight coloanal anastomosis versus a colonic J pouch

Abstract A meta-analysis of all randomized controlled trials comparing straight coloanal anastomosis to colonic J pouch anal anastomosis following rectal resection for low rectal cancer was performed. Five trials met the inclusion criteria. Overall, there were 141 patients randomized to straight coloanal anastomosis and 133 to colonic J pouch. There were no significant differences in the wound infection rate (OR 1.1; 95% CI 0.36-3.31), anastomotic leak rate (OR 1.2; 95% CI 0.39-3.72), or postoperative mortality (OR 7.99; 95% CI 0.5-128.3). Functional results were significantly better at 1-year follow-up in patients with a colonic J pouch. Thus, a smaller proportion of patients with a colonic J pouch had more than 3 bowel movements/day (OR 0.17; 95% CI 0.08-0.40), experienced urgency (OR 0.13; 95% CI 0.07-0.23), had nighttime soiling (OR 0.27; 95% CI 0.11-0.70), or used antidiarrheal medication (OR 0.26; 95% CI 0.11-0.59). These data suggest that the addition of a colonic J pouch leads to improved early functional results in patients having a sphincter-saving procedure for low rectal cancer. However, the overall quality of the trials was poor, so the results must be interpreted cautiously and more trials may be warranted. Copyright © 2002 by W.B. Saunders Company

Objective assessment of morbidity and quality of life after surgery for low rectal cancer.

OBJECTIVE: To determine whether an anterior resection for low rectal cancer is associated with less morbidity and a better quality of life than an abdominoperineal resection. PATIENTS AND METHODS: Fifty-three patients who had anterior resection for low rectal cancer were individually matched with 53 other patients, who had an abdominoperineal resection during the same period of time, for gender, age and socioeconomic status. There was no evidence of tumour recurrence in these patients. All patients answered three quality of life questionnaires at least one year after surgery: Short Form 36 version 2, EORTC QLQ-C30 and EORTC QLQ-CR38. Details on short-term and long-term complications were collected prospectively. RESULTS: There was no significant difference in both the short-term and the long-term complication rates between the two groups of patients. There was also no difference in the global quality of life score on the QLQ-C30. However, patients who had an anterior resection had a better perception of body image than those who had an abdominoperineal resection, as measured on the QLQ-CR38 questionnaire (P=0.009), but were more prone to suffer from constipation (P=0.001). CONCLUSIONS: The overall similarities in quality of life between the two groups is probably a reflection of better stoma care, although problems with body image still persist in stoma patients.

Coloanal anastomosis: Maintaining sphincter function after resection of low rectal cancer

Coloanal anastomosis: Maintaining sphincter function after resection of low rectal cancer

下部直腸癌切除後の局所再発例の検討

下部直腸癌切除後の局所再発例の検討

下部直腸癌に対する低位前方切除術の長期予後

下部直腸癌に対する低位前方切除術の長期予後

Anorectal reconstruction after abdominoperineal resection. Experience with double-wrap graciloplasty supported by low-frequency electrostimulation.

The aims of the study contained herein were to analyze the efficacy and safety of a chronically electrostimulated double-wrap graciloplasty for restoration of continence after a curative abdominoperineal resection for rectal carcinoma and to evaluate late results of a stimulation protocol that was begun early. During the last six years, 31 consecutive patients underwent this procedure: in 24 patients, electrostimulated double-wrap graciloplasty was performed simultaneously with abdominoperineal resection for lower rectal cancer, 7 strictly selected patients underwent conversion to an abdominal stoma following previous abdominoperineal resection (mean length of time from stoma creation, 71.4 months) Anorectal reconstruction was performed following a surgical scheme already standarized since 1985 in 102 patients: after abdominoperineal resection, the distal colon was pulled through to the perineum and surrounded by both gracilis muscles following an "alfa and new-sling" configuration; using platinumiridium electrodes, both muscles were then connected to pulse generator, which was implanted subcutaneously in the abdomen. All surgical steps were performed during the same surgical session to allow early postoperative stimulation of the transposed muscles. A contemporary covering stoma was abandoned as a standard procedure; the distal colon was left closed for a few postoperative days, then it was resected and sutured to the perineum under local anesthesia. Eighteen patients underwent preoperative or postoperative radiotherapy or both, without any significant adverse outcome. To increase gracilis resistance to prolonged "tonic" contraction, patients underwent a chronic, low-frequency stimulation protocol. In the last 11 patients, a new "over-the-nerve and intramuscular" implant was adopted to optimize fiber recruitment and to reduce electrostimulation thresholds. At regular intervals, all patients were evaluated using continence scores and questionnaires, electromanometry, endoluminal ultrasound study, and defecography. Twenty-six of 31 patients were evaluated for continence, with a mean length of follow-up of 37.8 (range, 4-68) months; 3 patients died because of cancer recurrence, 1 underwent conversion to an abdominal stoma, and 1 is waiting for stoma closure. Continence to liquid and solid stools was achieved in 22 patients (85 percent), and electromanometry findings confirmed a good muscular contraction postoperatively and during follow-up intervals. No postoperative mortality (40 days) was observed; the postoperative complication rate was high 22-percent), but early treatment (drainage and temporary diversion in 7 patients) led to favorable outcomes (4 resolutions, 3 partial muscular impairments). Four stimulators had to be temporarily explanted because of late complications, and two stimulators had to be replaced because of battery exhaustion after three years of use with high stimulation parameters. A significant difference was observed comparing full-contracting threshold after intramuscular (14 patients) and the new over-the-nerve and intramuscular implant technique. The study contained herein confirms the efficacy of the surgical scheme we have adopted since 1985 to reconstruct sphincteric apparatus after abdominoperineal resection of the rectum. The "one-step" timing of surgical and electrostimulation-related procedures and the early start of stimulation did not show a significant increase in the complication rate and did not produce noticeable muscular or nerve damage. Adoption of chronic electrostimulation protocols using implantable devices increased the rate of fully continent patients; nevertheless, the overall cost for devices and medical staff duties was high, and a small increase of late morbidity was observed. Finally, the preliminary experience with our new technique of electrode implants encourages further application.

Safety margin in anus-saving resection for low rectal cancer

The length and method of measurement of the safety-margin below the rectal cancer, being of the utmost importance for its prognosis, is still under debate. The following study was designed and done for its solution.

Coloanal anastomosis after resection of low rectal cancer in the elderly

Twenty-two patients had coloanal anastomoses performed after resection of low rectal tumors (16 adenocarcinomas and 6 large degenerated villous adenomas). The patients had an average age of 72 years (range: 62-85). A hand-sewn anastomosis was performed between a "J"-shaped colonic reservoir and the anal sphincter, except in 3 patients who underwent a straight end-to-end coloanal suture without pouch. A defunctionalized stoma was made in 18 cases. Mortality within 30 days of operation was 9%. Specific complications occurred in 2 patients (9%). Mean follow-up in this series was 20.2 +/- 11.7 months (+/- standard deviation). Fifteen patients were alive and free of disease up to 54 months after surgery. One patient was found to have local recurrence at 19 months. The actuarial 3-year survival rate was 73% in the whole group (operative mortality included). Functional results were good in 16 of 19 patients, with an average 1.8-2.9 stools/24 hours and the continence rate was good. Three patients had complications requiring a permanent colostomy. From these preliminary results, coloanal anastomosis appears to be satisfying in regard to oncologic results and affords good anal function, even in the elderly patient (over 62 years of age).