Evaluation of anal function after surgery for rectal cancer

Fm, Di Matteo; Mascagni, Domenico; Zeri, Kenneth Paul; Torretta, A; Matteo, F M Di; Maturo, A; Peparini, Nadia

doi:10.1002/1096-9098(200005)74:1<11::aid-jso3>3.0.co;2-d

Cited by 8 publications

(18 citation statements)

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“…To preserve continence, ultra low anastomoses are necessary after TME. Continence and quality of life are affected by the level of the straight anastomosis [2][3][4][5]18]. Associated problems can be improved by colonic J-pouch reconstruction [7][8][9][10][11][12][13]18].…”

Section: Discussionmentioning

confidence: 99%

“…Bittdorf et al obtained similar results for their colopouch anal group after intersphinctal resection-55% of patients were incontinent for liquid stool at least once a week. Depending on the level of the anastomosis, Matteo et al reported good continence for 56% of their patients with a colorectal straight anastomosis and for 45% with a coloanal straight anastomosis [3]. Dehni et al showed that 45%-55% of their patients were incontinent for flatus [12].…”

Section: Discussionmentioning

confidence: 99%

“…Another problem in this context is inadequate or missing discrimination, which involved 50% of patients with a colopouch rectal anastomosis and 59% of patients with a colopouch anal anastomosis. Similar results have also been reported in the literature: rectal straight anastomosis 22% [3], anal straight anastomosis 44% [3], J-pouch anastomosis 35% [25], and straight anastomosis 48% [25]. ''Impulse to defecate'' and ''warning period'' were comparable for both groups.…”

Section: Discussionmentioning

confidence: 99%

“…It is well known that the height of the straight anastomosis is of decisive importance for continence performance [2][3][4][5]. Whenever oncologically justifiable part of the rectum should thus be preserved, because continence performance decreases markedly with intersphincteric resection [6].…”

Section: Introductionmentioning

confidence: 98%

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Effect of Anastomosis Level on Continence Performance and Quality of Life after Colonic J-pouch Reconstruction

et al. 2007

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Total mesorectal excision (TME) has become the recommended method for treatment of cancer in the middle or lower third of the rectum. Thus very low anastomoses are necessary to preserve continence, and pouch reconstruction is favored. It is unclear whether the level of anastomosis is important for continence and quality of life in colonic J-pouch reconstruction. In this investigation all patients were included who underwent curative elective anterior continuity resection with colorectal or coloanal J-pouch reconstruction for primary rectal cancer between January 2001 and December 2004. Exclusion criteria were distant metastases and any signs of recurrence at the time of investigation. Evaluation of continence performance by Wexner and Holschneider questionnaire and quality of life using the QLQ-C30 and QLQ-CR38 (EORTC) questionnaires was done 220 +/- 38 days after closure of the protective Ileostomy, which was performed 106 +/- 48 days after primary intervention. Fifty-two patients (79%) were analyzed. Colopouch rectal anastomosis was performed in eighteen cases and colopouch anal anastomosis in thirty-four cases. Fifty percent of the patients in both groups were continent for solid stool. Patients with a colopouch anal anastomosis had a significantly higher rate of incontinence for liquid stool, however. They took stool-regulating medicine more frequently and complained of fecal soiling and a restricted quality of life. Patients with a colopouch anal anastomosis had a significantly lower score on the most important points of the QLQ-C30 (emotional functioning, social functioning, pain, and quality of life). The same applied to the QLQ-CR38 for body image and problems with defecation. The quality of life of patients with a colopouch anal anastomosis was still considered acceptable compared with reference data for the normal healthy population, however. Both continence and quality of life are substantially affected by the level of the anastomosis after colonic pouch reconstruction. This suggests preservation of a small part of the rectum when oncologically feasible and performing a colopouch rectal anastomosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

See 2 more Smart Citations

Effect of Anastomosis Level on Continence Performance and Quality of Life after Colonic J-pouch Reconstruction

et al. 2007

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“…In cases of cancer at low location, it is only allowable to resect the rectum along with part of the anus (particularly including the internal anal sphincter, but also with inclusion of the entire internal and part of the external anal sphincter), if this guarantees appropriate quality of the resection margin and preserves the efficiency of the sphincter apparatus to control defecation (10,11,12). Preservation of a rectal stump favours better bowel and gas continence (13).…”

Section: R E V I E W P a P E R Smentioning

confidence: 99%