J-pouch vs side-to-end coloanal anastomosis after preoperative radiotherapy and total mesorectal excision for rectal cancer: a multicentre randomized trial.

Abstract

AIM:

Comparison of functional and surgical outcome of the J-pouch with the side-to-end coloanal anastomosis after preoperative radiotherapy and total mesorectal excision in rectal cancer patients.

METHOD:

In a multicentre study, patients with a carcinoma of the lower two-thirds of the rectum were randomized to either a J-pouch or a side-to-end reconstruction. Primary outcome was function of the neorectum 1 year after surgery. A functional outcome [COloREctal Functional Outcome (COREFO)] questionnaire, and two quality of life questionnaires (EORTC-QLQ-CR38 and SF-36) were to be completed by all participants preoperatively, and 4 and 12 months postoperatively. Independent data managers recorded surgical outcome. A group size of 30 patients in each group was calculated based on a 15-point difference of the COREFO scale.

RESULTS:

In total, 107 patients were randomized, 55 in the J-pouch group and 52 in the side-to-end anastomosis group. The COREFO incontinence scale at 4 months and the total functional outcome at 4 and 12 months showed better results for the J-pouch group in comparison with the side-to-end anastomosis group. The remaining COREFO scales (frequency, social impact, stool-related aspects and bowel medication), surgical outcome (complications, reoperations, length of hospital stay, readmissions and mortality) and quality of life did not show significant differences between treatment groups.

CONCLUSION:

The overall results of a coloanal J-pouch and a side-to-end anastomosis are comparable, although functional results are slightly better with a J-pouch. The side-to-end anastomosis is technically less demanding and therefore a justified alternative in sphincter-saving surgery.

• Authors: A Doeksen, R Bakx, A Vincent, W F van Tets, M A G Sprangers, M F Gerhards, W A Bemelman, J J B van Lanschot
• Journal: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland (Colorectal Dis) Vol. 14 Issue 6 Pg. 705-13 (Jun 2012) ISSN: 1463-1318 [Electronic] England
• PMID: 21831100 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

Topics

• Adult
• Aged
• Aged, 80 and over
• Anal Canal (physiology, surgery)
• Anastomosis, Surgical
• Carcinoma (radiotherapy, surgery)
• Colon (physiology, surgery)
• Colonic Pouches (physiology)
• Fecal Incontinence (etiology)
• Female
• Humans
• Male
• Middle Aged
• Neoadjuvant Therapy
• Organ Sparing Treatments
• Quality of Life
• Rectal Neoplasms (radiotherapy, surgery)
• Severity of Illness Index
• Statistics, Nonparametric
• Surveys and Questionnaires