LEVEL OF ANASTOMOSIS AND ANORECTAL MANOMETRY IN PREDICTING FUNCTION FOLLOWING ANTERIOR RESECTION FOR ADENOCARCINOMA

The clinical and physiological consequences of sphincter preservation after resection of rectal carcinoma at various levels were evaluated. Thirty-two patients (mean age 59.2 years; range 31-79 years) who had u ndergone curative surgery at least one year previously and were not gi ven adjuvant therapy, were studied with 19 normal controls. Three blin ded observers independently assessed clinical sphincter function, leve l of anastomosis (ANL) and anorectal manometry. 85.7% had an increase in stool frequency but their normal lifestyles were unaffected. The me an stool frequency was 3.1 (range 2 to 8) times/day. The anal maximal basal and maximum squeeze pressures, rectal volume of first sensation (VIS) and urge, maximum tolerable volume and compliance were all signi ficantly impaired (P < 0.05). Patients with poorer function had signif icantly lower ANLs (P < 0.05). On multiple regression analysis, the AN L and the VIS significantly predicted stool frequency (P < 0.05). ANL below 6 cm was significantly associated with impaired frequency of sto ols (P < 0.05). This may be a subgroup of patients whose residual rect al reservoir function is compromised and may theoretically benefit fro m colonic pouches.