INDICATIONS FOR COLONIC J-POUCH RECONSTRUCTION AFTER ANTERIOR RESECTION FOR RECTAL-CANCER - DETERMINING THE OPTIMUM LEVEL OF ANASTOMOSIS

PURPOSE: Functional outcome after anterior resection for rectal cancer is improved by colonic J-pouch reconstruction compared with straight anastomosis. The indications for colonic J-pouch reconstruction have p et to be determined. Therefore, we attempted to determine the level at which J-pouch reconstruction provides an advantage over straight anas tomosis. METHODS: A total of 48 patients who under went 5-cm colonic J -pouch reconstruction (J-pouch group) and 80 patients who underwent st raight anastomosis (straight group) underwent functional assessment on e year postoperatively. RESULTS: The functional outcome in the J-pouch group was significantly better than that in the straight group when t he distance of the anastomosis from the anal verge was less than 8 cm. The difference was particularly obvious when the level of the anastom osis was below 4 cm. However, functional outcome in the straight group when the anastomosis was between 9 and 12 cm from the anal verge was also satisfactory and did not differ from that in the J-pouch group wh en the anastomosis was between 5 and 8 cm from the anal verge. CONCLUS IONS: Colonic J-pouch reconstruction is indicated when the distance of anastomosis from the anal verge is less than 8 cm, and it is essentia l when the distance is less than 4 cm.