Ultralow Anterior Resection and Coloanal Anastomosis for Distal Rectal Cancer Functional and Oncologic Results.
- Author:
Nam Kyu KIM
1
;
Dae Jin LIM
;
Seong Hyeon YUN
;
Kang Young LEE
;
Seung Kook SOHN
;
Jin Sik MIN
Author Information
1. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Rectal cancer;
Coloanal anastomosis;
Ultralow anterior resection
- MeSH:
Anal Canal;
Anastomotic Leak;
Autonomic Pathways;
Colon;
Colonic Pouches;
Constriction, Pathologic;
Fecal Incontinence;
Humans;
Postoperative Complications;
Rectal Neoplasms*;
Rectovaginal Fistula;
Recurrence;
Urinary Retention
- From:Journal of the Korean Society of Coloproctology
2000;16(5):334-338
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Coloanal anastomosis (CAA) following ultralow anterior resection became more popular techniques for preservation of anal sphincter in distal rectal cancer. The purpose of this study is to evaluate a functional and oncologic safety of patients who underwent ultralow anterior resection and coloanal anastomosis for distal rectal cancer. METHODS: Forty-eight patients underwent coloanal anastomosis following ultralow anterior resection between January 1988 and January 1998. Main operative techniques were total mesorectal excision with autonomic nerve preservation. Colonic J pouch was made 8 cm in length with GIA 95. All patients were followed up for fecal or gas incontinence, frequency of bowel movement and local or systemic recurrences. RESULTS: Mean tumor distance from anal verge was 4.0 cm. Postoperative complications were transient urinary retention (N=7), anastomotic stenosis (N=3), anastomotic leakage (N=3), rectovaginal fistula (N=2), cancer positive margin (N=1; patient refuses reoperation). Overall recurrences occurred in 7/48 (14.5%). Local recurrence (N=1) and systemic recurrence (N=1) in Astler-Coller stage B2, local recurrence (N=1), systemic recurrence (N=2) and combined local and systemic recurrence (N=2) in Astler-Coller stage C2. Mean frequency of bowel movement were 6.1 per day at 3 month, 4.4 at 1 year and 3.1 at 2 years. Kirwan grade for fecal incontinence were 2.7 at 3 months, 1.8 at 1 year and 1.5 at 2 years. CONCLUSIONS: With careful selection of patients and good operative techniques, CAA can be performed safely in distal rectal cancer. Normal continence and acceptable frequency of bowel movements can be obtained at 1 year after operation without compromising the rate of local recurrence.
