Straight and colonic J-pouch coloanal anastomosis. Short-term and long-term results

Study aim: This retrospective study was designed to assess the operative, o ncologic and functional results of total proctectomy with coloanal anastomo sis (CAA). Patients and method: Between 1990 and 1994, 81 patients (44 males / 37 fema les: mean age: 59 years) were operated for a cancer (n = 67) err a benign l esion (n = 14) of the rectum. Sixty-four patients had a straight CAA and 17 patients had a colonic J-pouch. Results: There was no operative mortality. Thio patients were reoperated fo r colonic necrosis and underwent abdominoperineal resection. An anastomotic leak was observed in ii patients and its severity was decreased by a diver ting stoma. An anastomotic stricture was observed in 10 patients. Of the 67 patients with cancer, 19 (28%) developed metastases and II (16%) developed local recurrence. The 5-year survival rate was 69%. Twelve months after the operation, continence was similar with ii-ie two ty pes of CAA, but the mean daily stool frequency was lower in patients with a reservoir. With a long follow-up (mean = 9 years), functional results were good with regard to continence and stool frequency, almost similar with th e two types of CAA; functional disorders (nocturnal stools, fragmentation, urgency) were reported Gy 25 to 40% of patients. Conclusion: Total proctectomy with colonial anastomosis yields good oncolog ic results. With regard to functional results, the superiority of the colon ic J-pouch, which is observed in the first postoperative year, was lost bey ond this period; long-term results are good for continence and stool freque ncy, but some disorders persist in a significant proportion of patients. (C ) 2001 Editions scientifiques et medicales Elsevier SAS.