FUNCTIONAL OUTCOME AFTER LOW ANTERIOR RESECTION WITH LOW ANASTOMOSIS FOR RECTAL-CANCER USING THE COLONIC J-POUCH - PROSPECTIVE RANDOMIZED STUDY FOR DETERMINATION OF OPTIMUM POUCH SIZE

PURPOSE: Functional outcome after low anterior resection with ultralow coloanal anastomosis for rectal cancer is improved by construction of a colonic J-pouch vs. straight anastomosis. Optimum size of this pouc h has yet to be determined. Therefore, we initiated a prospective, ran domized trial using 5-cm and 10-cm pouches to determine this size. MET HODS: Patients with tumors 5 to 10 cm from the anal verge were include d in the study. Before a low anterior resection anastomosis was perfor med, patients were randomized to either a 5-cm J-pouch group (5-J grou p) or a 10-cm J-pouch group (10-J group). Functional assessments were performed one year postoperatively. Clinical functions were evaluated using a functional scoring system. Physiologic functions, such as sphi ncter and reservoir function, were evaluated by anorectal manometry an d evacuation function by the balloon expulsion and saline evacuation t ests. RESULTS: Forty patients among 43 randomized patients were assess ed for functional outcome one year postoperatively (5-J group, n = 20; 10-J group, n = 20). The functional score was similar for the two gro ups, although reservoir function in the 5-J group was significantly le ss than in the 10-J group. Sphincter function was similar between the two groups. Evacuation function in the 5-J group was significantly sup erior to that in the 10-J group. CONCLUSIONS: The 5-cm J-pouch conferr ed adequate reservoir function without compromising evacuation.