Meta-analysis of reconstruction techniques after low anterior resection for rectal cancer

Hüttner, Felix J; Tenckhoff, Solveig; Jensen, Katrin; Uhlmann, Lorenz; Kulu, Yakup; Büchler, Markus W.; Diener, Markus K.; Ulrich, Alexis

doi:10.1002/bjs.9782

Cited by 100 publications

(76 citation statements)

References 34 publications

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“…The present trial failed to demonstrate any benefit of a J pouch in reducing the rate of AL, and was unable to confirm the findings of studies that foresaw a significant advantage of CJP over the traditional SCRA technique. Differences in primary endpoint, study design, definition of selection criteria and method of diagnosis of AL might explain discrepancies between the present results and those of previous studies.…”

Section: Discussioncontrasting

confidence: 99%

“…It may also have an adverse effect on long‐term bowel function, quality of life, cancer‐specific survival, local recurrence and rate of permanent stoma. Previous studies reported that the incidence of major AL was reduced when CJP reconstruction was performed in patients with a stapled colorectal anastomosis. Another recently described technique of reconstruction is the side‐to‐end colorectal anastomosis, which could potentially have been included in this trial.…”

Section: Discussionmentioning

confidence: 99%

“…This result was attributed to better vascularization of the J pouch apex, as detected by Doppler ultrasound imaging. Others have shown a trend towards a favourable impact of CJP reconstruction in terms of reducing the rate of AL compared with SCRA.…”

Section: Introductionmentioning

confidence: 87%

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Multicentre randomized clinical trial of colonic J pouch or straight stapled colorectal reconstruction after low anterior resection for rectal cancer

Pucciarelli

Bianco

Pace

et al. 2019

British Journal of Surgery

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Background Colonic J pouch reconstruction has been found to be associated with a lower incidence of anastomotic leakage than straight anastomosis. However, studies on this topic are underpowered and retrospective. This randomized trial evaluated whether the incidence of anastomotic leakage was reduced after colonic J pouch reconstruction compared with straight colorectal anastomosis following anterior resection for rectal cancer. Methods This multicentre RCT included patients with rectal carcinoma who underwent low anterior resection followed by colorectal anastomosis. Patients were assigned randomly to receive a colonic J pouch or straight colorectal anastomosis. The main outcome measure was the occurrence of major anastomotic leakage. The incidence of global (major plus minor) anastomotic leakage and general complications were secondary outcomes. Risk factors for anastomotic leakage were identified by regression analysis. Results Of 457 patients enrolled, 379 were evaluable (colonic J pouch arm 190, straight colorectal arm 189). The incidence of major and global anastomotic leakage, and general complications was 14·2, 19·5 and 34·2 per cent respectively in the colonic J pouch group, and 12·2, 19·0 and 27·0 per cent in the straight colorectal anastomosis group. No statistically significant differences were observed between the two arms. In multivariable logistic regression analysis, male sex (odds ratio 1·79, 95 per cent c.i. 1·02 to 3·15; P = 0·042) and high ASA fitness grade (odds ratio 2·06, 1·15 to 3·71; P = 0·015) were independently associated with the occurrence of anastomotic leakage. Conclusion Colonic J pouch reconstruction does not reduce the incidence of anastomotic leakage and postoperative complications compared with conventional straight colorectal anastomosis. Registration number NCT01110798 (http://www.clinicaltrials.gov/).

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Multicentre randomized clinical trial of colonic J pouch or straight stapled colorectal reconstruction after low anterior resection for rectal cancer

Pucciarelli

Bianco

Pace

et al. 2019

British Journal of Surgery

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“…Another study limitation is the type of anastomosis employed since previous literature has proven that type of anastomosis could be of influence on functional outcome [23, 24]. Patients in the LAR group had a side-to-end anastomosis, while patients in the TaTME group had an end-to-end anastomosis.…”

Section: Discussionmentioning

confidence: 99%

Quality of life after rectal cancer surgery: differences between laparoscopic and transanal total mesorectal excision

et al. 2018

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“…The more proximity to anal verge, the more risk of rectal dysfunction. Thus for distal rectal cancer (2-6 Cm from anal verge), it is preferred to save anal canal as possible (Tenckhoff et al, 2015). In our study the proximity to anal verge was 3-8Cm.…”

Section: Discussionmentioning

confidence: 50%

Extended Low Anterior Resection with a Circular Stapler in Patients with Rectal Cancer: a Single Center Experience

Talaeezadeh

Bahadoram²,

Abtahian

et al. 2016

Asian Pacific Journal of Cancer Prevention

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Background: to evaluate the outcome of stapled colo-anal anastomoses after extended low anterior resection for distal rectal carcinoma. Materials and Methods: A retrospective study of fifty patients who underwent coloanal anastomoses after extended low anterior resection was conducted at Imam Hospital from September 2007 up to July 2012. Results: The distance of the tumor from anal verge was 3 to 8 cm. Anastomotic leakage developed in 6% of patients and defecation problems in 16% . One-year local recurrence was 6% while three-year local recurrence was 4%. One-year systemic recurrence was seen in 22% while three-year systemic recurrence was seen in 20%. Conclusions: Colo-anal anastomoses after extended low anterior resection for distal rectal carcinoma can be conducted safely.

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Meta-analysis of reconstruction techniques after low anterior resection for rectal cancer

Abstract: Colonic J pouch and side-to-end CAA or transverse coloplasty lead to a better functional outcome than straight CAA for the first year after surgery.

Cited by 100 publications

References 34 publications

Multicentre randomized clinical trial of colonic J pouch or straight stapled colorectal reconstruction after low anterior resection for rectal cancer

Multicentre randomized clinical trial of colonic J pouch or straight stapled colorectal reconstruction after low anterior resection for rectal cancer

Quality of life after rectal cancer surgery: differences between laparoscopic and transanal total mesorectal excision

Extended Low Anterior Resection with a Circular Stapler in Patients with Rectal Cancer: a Single Center Experience

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