A Randomized Multicenter Trial to Compare Long-Term Functional Outcome, Quality of Life, and Complications of Surgical Procedures for Low Rectal Cancers

Abstract

Introduction: Colonic pouches have been used for 20 years to provide reservoir function after reconstructive proctectomy for rectal cancer. More recently coloplasty has been advocated as an alternative to a colonic pouch. However there have been no longterm randomized, controlled trials to compare functional outcomes of coloplasty, colonic J-Pouch (JP), or a straight anastomosis (SA) after the treatment of low rectal cancer. Aim: To compare the complications, long-term functional outcome, and quality of life (QOL) of patients undergoing a coloplasty, JP, or an SA in reconstruction of the lower gastrointestinal tract after proctectomy for low rectal cancer. Methods: A multicenter study enrolled patients with low rectal cancer, who were randomized intraoperatively to coloplasty (CP-1) or SA if JP was not feasible, or JP or coloplasty (CP-2) if a JP was feasible. Patients were followed for 24 months with SF-36 surveys to evaluate the QOL. Bowel function was measured quantitatively and using Fecal Incontinence Severity Index (FISI). Urinary function and sexual function were also assessed. Results: Three hundred sixty-four patients were randomized. All patients were evaluated for complications and recurrence. Mean age was 60 Ϯ12 years, 71% were male. Twenty-three (7.4%) died within 24 months of surgery. No significant difference was observed in the complications among the 4 groups. Two hundred ninety-seven of

S3-Leitlinie – Kolorektales Karzinom

“…Bei Anlage eines J-Pouches sollte zur Vermeidung von Entleerungsproblemen die Schenkellänge nicht über 6 cm liegen [750]. Die einzige grö-ßere prospektiv randomisierte Studie zur Frage des differenziellen Einsatzes verschiedener Rekonstruktionen [747] [748]. Zur endgültigen Beurteilung des Stellenwerts der Seit-zu-End-Anastomose fehlen noch Studien mit ausreichender Fallzahl [749].…”

S3-Leitlinie Kolorektales Karzinom Version 1.0 - Juni 2013 AWMF-Registernummer: 021/007OL

“…Bei Anlage eines J-Pouches sollte zur Vermeidung von Entleerungsproblemen die Schenkellänge nicht über 6 cm liegen [625]. Die einzige größere prospektiv randomisierte Studie zur Frage des differenziellen Einsatzes verschiedener Rekonstruktionen [622] Hintergrund Es existiert hierzu bisher nur eine einzige abgeschlossene randomisierte Studie zum Vergleich zwischen systemischer Chemotherapie und zytoreduktiver Chirurgie mit HIPEC [660]. Diese Studie konnte auch im Langzeitverlauf belegen, dass die chirurgische Therapie der Peritonealkarzinose zu signifikant besserem krankheits-spezifischem Überleben führt [661].…”

Laparoscopic extraperitoneal rectal cancer surgery: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)

“…Controversy exists about the type of anastomosis to use in low anterior resection and coloanal anastomosis: straight anastomosis, J pouch anastomosis, transverse coloplasty or end-to-side anastomosis [106][107][108][109][110][111]. One review concludes that probably end-to-side anastomosis will result in the same functional quality of life as pouch anastomosis [109].…”