Comparison of functional and surgical outcomes of laparoscopic-assisted colonic J-pouch versus straight reconstruction after total mesorectal excision for lower rectal cancer
Journal
Annals of Surgical Oncology
Journal Volume
14
Journal Issue
7
Pages
1972-1979
Date Issued
2007
Abstract
Background: To compare the functional and surgical outcomes of colonic J-pouch and straight anastomosis in the context that both reconstruction procedures were performed laparoscopically. Methods: The present study was a randomized prospective clinical trial. Patients with lower rectal cancer requiring laparoscopic total mesorectal excision were equally randomized to either laparoscopic-assisted colonic J-pouch reconstruction or laparoscopic straight end-to-end anastomosis. The techniques of the laparoscopic-assisted colonic J-pouch reconstruction are shown in the attached video. The primary end point was the comparison of functional results in both reconstruction methods. The secondary end points included the safety (surgical morbidity and mortality), surgical efficiency, and postoperative recovery. Results: A total of 48 patients were recruited within 2-year periods, in consideration of statistical power of 90% for comparison. There was no marked difference between patient groups undergoing colonic J-pouch surgery (n = 24) and straight anastomosis (n = 24) in various demographic and clinicopathogic parameters. The anorectal function of patients by colonic J-pouch were better than those by straight anastomosis in 3 months after operation, as evaluated by stool frequency (mean ± standard deviation: 4.0 ± 2.0 vs. 7.0 ± 2.4 times/day, P < .001); use of antidiarrheal agents (29.2% [n = 7] vs. 75.0% [n = 18], P = .004); and perineal irritation (45.8% [n = 11] vs. 79.2% [n = 19], P = .037). Because of the relatively better bowel function in immediate postoperative period, patients by colonic J-pouch reconstruction were less disabled after surgery and had quicker return to partial activity (P = .039), full activity (P < .001), and work (P < .001). Both reconstruction methods were performed with similar amounts of blood loss, complication rates, and postoperative recovery. However, the operation time was significantly longer in the colonic J-pouch group (274.4 ± 34.0 vs. 202.0 ± 28.0 minutes, P < .001). Conclusions: Because laparoscopic-assisted creation of a colonic J-pouch achieved better short-term functional results of the anorectum and did not increase surgical morbidity, as compared with laparoscopic straight anastomosis, this reconstruction procedure could be recommended to patients with lower rectal cancer requiring laparoscopic total mesorectal excision. ? 2007 Society of Surgical Oncology.
SDGs
Other Subjects
antidiarrheal agent; adult; article; bleeding; clinical article; clinical trial; colon pouch; controlled clinical trial; controlled study; convalescence; end to end anastomosis; feces; female; human; intermethod comparison; intestine function; laparoscopic surgery; male; morbidity; operation duration; pathology; patient safety; perineum; postoperative complication; postoperative period; prospective study; randomized controlled trial; rectum; rectum cancer; statistical analysis; surgical mortality; surgical technique; treatment outcome; Aged; Anastomosis, Surgical; Colonic Pouches; Double-Blind Method; Female; Humans; Intestine, Large; Laparoscopy; Male; Middle Aged; Proctocolectomy, Restorative; Prospective Studies; Recovery of Function; Rectal Neoplasms; Treatment Outcome
Type
journal article