LONG-TERM FUNCTIONAL OUTCOME AFTER LOW ANTERIOR RESECTION - COMPARISON OF LOW COLORECTAL ANASTOMOSIS AND COLONIC J-POUCH ANAL ANASTOMOSIS

OBJECTIVE: The purpose of this study was to compare long-term function al results of two methods of reconstruction after anterior rectal rese ction for cancer: low colorectal anastomosis and colonic J-pouch-anal anastomosis. SUMMARY BACKGROUND DATA. After anterior resection for mid or low rectal cancer, the decision to perform low colorectal or coloa nal anastomosis is made intraoperatively, depending on the distance of the tumor from the anal verge. Functional results of these operations are considered to be similar one to two years after surgery. No study to date has compared long-term functional results after rectal excisi on followed by either low colorectal anastomosis or colonic J-pouch-an al anastomosis. METHODS: From 1987 to 1992, 173 patients underwent ant erior resection for cancer located between 2 to 12 cm from the anal ve rge. All patients alive without recurrence were contacted by telephone interview for assessment of functional results. There were 47 patient s with colonic J-pouch-anal anastomosis and 34 patients with low color ectal anastomosis. Minimum followup was three years Ibr all patients ( mean, 5 years). RESULTS: The two groups were well matched for gender, age, histologic stage, and use of adjuvant therapies. Patients with co lonic J-pouch-anal anastomosis displayed significantly bet ter functio n in terms of frequency of defecation (1.57 +/- 1 vs. 2.79 +/- 1; P = 0.001) and presence of irregular transit or stool ''clustering'' (30 v s. 71 percent, P = 0.003). Patients who underwent colonic J-pouch-anal anastomosis were significantly less likely to require constipating ag ents (4 vs. 21 percent; P = 0.03) or need to follow a restricted diet (14 vs. 41 percent, P = 0.01). Results concerning the need to defecate again within one hour and disruption of social or professional life a s a consequence of surgery showed a tendency in favor of colonic J-pou ch-anal anastomosis. CONCLUSION: Colonic J-pouch-anal anastomosis offe rs superior long-term function compared with low colorectal anastomosi s after radical treatment of rectal cancer. Preservation of a short re ctal segment followed by a straight colorectal anastomosis does not of fer any clinical advantage over colonic J-pouch-anal anastomosis.