Clin Colon Rectal Surg 2002; 15(1): 043-054
DOI: 10.1055/s-2002-23567
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Sphincter-Saving and Reconstruction Techniques Following Rectal Cancer Resection

Miguel Pera, Heidi Nelson
  • Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN
Further Information

Publication History

Publication Date:
03 April 2002 (online)

ABSTRACT

Low anterior resection and coloanal anastomosis are often associated with significant impairments in anorectal function, changes that adversely affect the quality of life of patients undergoing resective surgery for rectal cancer. In an attempt to improve the functional results of sphincter-saving procedures, new reconstructive techniques such as the colonic pouch and the tranverse coloplasty have been reported. This article will describe technical aspects as well as functional and oncologic results for sphincter-saving and reconstructive procedures that are performed for rectal cancer.

REFERENCES

  • 1 Heald R, Smedh R, Kald A, Sexton R, Moran B. Abdominoperineal excision of the rectum-an endangered operation.  Dis Colon Rectum . 1997;  40 747-751
  • 2 Nelson H, Petrelli N, Carlin A. Guidelines 2000 for colon and rectal cancer surgery.  J Natl Cancer Inst . 2001;  93 583-596
  • 3 Rullier E, Goffre B, Bonnel C, Zerbib F, Caudry M, Saric J. Preoperative radiochemotherapy and sphincter-saving resection for T3 carcinomas of the lower third of the rectum.  Ann Surg . 2001;  234 633-640
  • 4 De Haas-Kock D, Baeten C, Jager J. Prognostic significance of radial margins of clearance in rectal cancer.  Br J Surg . 1996;  83 781-785
  • 5 Zirngibl H, Husemann B, Hermanek P. Intraoperative spillage of tumor cells in surgery for rectal cancer.  Dis Colon Rectum . 1990;  33 610-614
  • 6 Sugarbaker P, Corlew S. Influence of surgical techniques on survival in patients with colorectal cancer.  Dis Colon Rectum . 1982;  25 545-557
  • 7 Paty P, Enker W, Cohen A, Lauwers G. Treatment of rectal cancer by low anterior resection with coloanal anastomosis.  Ann Surg . 1994;  219 365-373
  • 8 Cavaliere F, Pemberton J, Cosimelli M, Fazio V, Beart R. Coloanal anastomosis for rectal cancer.  Long-term results at the Mayo and Cleveland Clinics. Dis Colon Rectum . 1995;  38 807-812
  • 9 Nymann T, Jess P, Christiansen J. Rate and treatment of pelvic recurrence after abdominoperineal resection and low anterior resection for rectal cancer.  Dis Colon Rectum . 1995;  38 799
  • 10 Berger A, Tiret E, Cunningham C, Dehni N, Parc R. Rectal excision and colonic pouch-anal anastomosis for rectal cancer: oncologic results at five years.  Dis Colon Rectum . 1999;  42 1265-1271
  • 11 Kohler A, Athanasiadis S, Ommer A, Psarakis E. Long-term results of low anterior resection with intersphincteric anastomosis in carcinoma of the lower one-third of the rectum: analysis of 31 patients.  Dis Colon Rectum . 2000;  43 843-850
  • 12 Leo E, Belli F, Andreola S. Total rectal resection and complete mesorectum excision followed by coloendoanal anastomosis as the optimal treatment for low rectal cancer: the experience of the National Cancer Institute of Milano.  Ann Surg Oncol . 2000;  7 125-132
  • 13 Kim N, Lim D, Yun S, Sohn S, Min J. Ultralow anterior resection and coloanal anastomosis for distal rectal cancer: functional and oncological results.  Int J Colorectal Dis . 2001;  16 234-237
  • 14 Wolmark N, Fisher B. An analysis of survival and treatment failure following abdominoperineal and sphincter-saving resection in Dukes' B and C rectal carcinoma: a report of the NSABP clinical trials.  Ann Surg . 1986;  24 480-489
  • 15 Amato A, Pescatori M, Butti A. Local recurrence following abdominoperineal excision and anterior resection for rectal carcinoma.  Dis Colon Rectum . 1991;  34 317-322
  • 16 Dixon A R, Maxwell W, Holmes J. Carcinoma of the rectum: a 10-year experience.  Br J Surg . 1991;  78 308-311
  • 17 Gamagami R, Liagre A, Chitasso P, Istvan G, Lazorthes F. Coloanal anastomosis for distal third rectal cancer: prospective study of oncological results.  Dis Colon Rectum . 1999;  42 1272-1275
  • 18 Pollet W, Nicholls R. The relationship between the extent of distal clearance and survival and local recurrence rates after curative anterior resection for carcinoma of the rectum.  Ann Surg . 1983;  198 159-163
  • 19 Williams N, Dixon M, Johnston D. Reappraisal of the 5 centimetre rule of distal excision for carcinoma of the rectum: a study of distal intramural spread and of patients' survival.  Br J Surg . 1983;  70 150-154
  • 20 Sarela A, O'Riordain D. Rectal adenocarcinoma with liver metastases: management of the primary tumour.  Br J Surg . 2001;  88 163-164
  • 21 Read T, Kodner I. Proctectomy and coloanal anastomosis for rectal cancer.  Arch Surg . 1999;  134 670-677
  • 22 Saltz L, Cox J, Blanke C. Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer: Irinotecan study group.  N Engl J Med . 2000;  343 905-914
  • 23 De Gramont A, Figer A, Seymour M. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer.  J Clin Oncol . 2000;  18 2938-2947
  • 24 Watanabe M, Teramoto T, Hasegawa H, Kitajima M. Laparoscopic ultralow anterior resection combined with per anum intersphincteric rectal dissection for lower rectal cancer.  Dis Colon Rectum . 2000;  43 S94-S97
  • 25 Ichigara T, Nagahata Y, Nomura H. Laparoscopic low anterior resection is equivalent to laparotomy for lower rectal cancer at the distal line of resection.  Am J Surg . 2000;  179 97-98
  • 26 Vithiananthan S, Cooper Z, Betten K. Hybrid laparoscopic flexure takedown and open procedure for rectal resection is associated with significantly shorter length of stay than equivalent open resection.  Dis Colon Rectum . 2001;  44 927-935
  • 27 Vignali A, Fazio V, Lavery I. Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients.  J Am Coll Surg . 1997;  185 105-113
  • 28 Zaheer S, Pemberton J, Farouk R, Dozois R, Wolff B, Ilstrup D. Surgical treatment of adenocarcinoma of the rectum.  Ann Surg . 1998;  227 800-811
  • 29 Law W, Chu K, Ho J, Chan C. Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision.  Am J Surg . 2000;  179 92-96
  • 30 Karanjia N, Corder A, Bearn P, Heald R. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum.  Br J Surg . 1994;  81 1224-1226
  • 31 Dehni N, Schlegel R, Cunningham C, Guiguet M, Tiret E, Parc R. Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis and colonic J-pouch-anal anastomosis.  Br J Surg . 1998;  85 1114-1117
  • 32 Nesbakken A, Nygaard K, Lunde O. Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer.  Br J Surg . 2001;  88 400-404
  • 33 Olagne E, Baulieux J, de la Roche E. Functional results of delayed coloanal anastomosis after preoperative radiotherapy for lower third rectal cancer.  J Am Coll Surg . 2000;  191 643-649
  • 34 Sakai Y, Nelson H, Larson D, Maidl L, Young-Fadok T, Ilstrup D. Temporary transverse colostomy vs loop ileostomy in diversion.  Arch Surg . 2001;  136 338-342
  • 35 Williams N, Nasmyth D, Jones D, Smith A. Defunctioning stomas: a prospective controlled trial comparing loop ileostomy with loop transverse colostomy.  Br J Surg . 1986;  73 566-570
  • 36 Khoury G, Lewis M, Meleagros L, Lewis A. Colostomy or ileostomy after colorectal anastomosis?.  <~>A randomized trial. Ann R Coll Surg Engl . 1987;  69 5-7
  • 37 Gooszen A, Geelkerken R, Hermans J, Lagaay M, Gooszen H. Temporary decompression after colorectal surgery: randomized comparison of loop ileostomy and loop colostomy.  Br J Surg . 1998;  85 76-79
  • 38 Edwards D, Leppington-Clarke A, Sexton R, Heald R, Moran B. Stoma-related complications are more frequent after transverse colostomy than loop ileostomy: a prospective randomized clinical trial.  Br J Surg . 2001;  88 360-363
  • 39 Hallbook O, Sjodahl R. Anastomotic leakage and functional outcome after anterior resection of the rectum.  Br J Surg . 1996;  83 60-62
  • 40 Fichera A, Michelassi F. Long-term prospective assessment of functional results after proctectomy with coloanal anastomosis.  J Gastrointest Surg . 2001;  5 153-157
  • 41 Paty P, Enker W, Cohen A, Minsky B, Friedlander-Klar H. Long-term functional results of coloanal anastomosis for rectal cancer.  Am J Surg . 1994;  167 90-95
  • 42 Shibata D, Guillem J, Lanouette N. Functional and quality-of-life outcomes in patients with rectal cancer after combined modality therapy, intraoperative radiation therapy, and sphincter preservation.  Dis Colon Rectum . 2000;  43 752-758
  • 43 Miller A, Lewis W, Williamson M, Holdsworth P, Johnston D, Finan P. Factors that influence functional outcome after coloanal anastomosis for carcinoma of the rectum.  Br J Surg . 1995;  82 1327-1330
  • 44 Williamson M, Lewis W, Finan P, Miller A, Holdsworth P, Johnston D. Recovery of physiologic and clinical function after low anterior resection of the rectum for carcinoma: myth or reality?.  Dis Colon Rectum . 1995;  38 411-418
  • 45 Karanjia N, Schache D, Heald R. Function of the distal rectum after low anterior resection for carcinoma.  Br J Surg . 1992;  79 114-116
  • 46 Lewis W, Holdsworth P, Stephenson B, Finan P, Johnston D. Role of the rectum in the physiological and clinical results of coloanal and colorectal anastomosis after anterior resection for rectal carcinoma.  Br J Surg . 1992;  79 1082-1086
  • 47 Jehle E, Haehnel T, Starlinger M, Becker H. Level of the anastomosis does not influence functional outcome after anterior rectal resection for rectal cancer.  Am J Surg . 1995;  169 147-153
  • 48 Ho Y, Tan M, Leong A, Seow-Choen F. Ambulatory manometry in patients with colonic J-pouch and straight coloanal anastomoses: randomized, controlled trial.  Dis Colon Rectum . 2000;  43 793-799
  • 49 Lewis W, Martin I, Williamson M. Why do some patients experience poor functional results after anterior resection of the rectum for carcinoma?.  Dis Colon Rectum . 1995;  38 259-263
  • 50 Lazorthes F, Fages P, Chiotasso P, Lemozy J, Bloom E. Resection of the rectum with construction of a colonic reservoir and colo-anal anastomosis for carcinoma of the rectum.  Br J Surg . 1986;  73 136-138
  • 51 Parc R, Tiret E, Frileux P, Moszkowski E, Loygue J. Resection and colo-anal anastomosis with colonic reservoir for rectal carcinoma.  Br J Surg . 1986;  73 139-141
  • 52 Dehni N, Schlegel R, Tiret E, Singland J, Guiguet M, Parc R. Effects of aging on the functional outcome of coloanal anastomosis with colonic J-pouch.  Am J Surg . 1998;  175 209-212
  • 53 Ho Y, Tan M, Seow-Choen F. Prospective randomized controlled study of clinical function and anorectal physiology after low anterior resection: comparison of straight and colonic J-pouch anastomoses.  Br J Surg . 1996;  83 978-980
  • 54 Gervaz P, Rotholtz N, Wexner S. Colonic J-pouch function in rectal cancer patients.  Dis Colon Rectum . 2001;  44 1667-1675
  • 55 Hallbook O, Pahlman L, Krog M, Wexner S, Sjodahl R. Randomized comparison of straight and colonic J-pouch anastomosis after low anterior resection.  Ann Surg . 1996;  224 58-65
  • 56 Nicholls R, Lubowski D, Donaldson D. Comparison of colonic reservoir and straight colo-anal reconstruction after rectal excision.  Br J Surg . 1988;  75 318-320
  • 57 Joo J, Latulippe J, Alabaz O, Weiss E, Nogueras J, Wexner S. Long-term functional evaluation of straight coloanal anastomosis and colonic J-pouch: is the functional superiority of colonic J-pouch sustained?.  Dis Col Rectum . 1998;  41 740-746
  • 58 Ortiz H, De Miguel M, Armendariz P, Rodriguez J, Chocarro C. Coloanal anastomosis: are functional results better with a pouch?.  Dis Col Rectum . 1995;  38 375-377
  • 59 Willis S, Kasperk R, Braun J, Schumpelick V. Comparison of colonic J-pouch reconstruction and straight coloanal anastomosis after intersphincteric rectal resection.  Langenbeck's Arch Surg . 2001;  386 193-199
  • 60 Kusunoki M, Shoji Y, Yanagi H. Function after anoabdominal rectal resection and colonic J-pouch-anal anastomosis.  Br J Surg . 1991;  78 1434-1438
  • 61 Seow-Choen F, Goh H. Prospective randomized trial comparing J colonic-ouch-anal anastomosis and straight coloanal reconstruction.  Br J Surg . 1995;  82 608-610
  • 62 Lazorthes F, Chiotasso P, Gamagami R, Istvan G, Chevreau P. Late clinical outcome in a randomized propective comparison of colonic J-pouch and straight coloanal anastomosis.  Br J Surg . 1997;  84 1449-1451
  • 63 Ho Y, Seow-Choen F, Tan M. Colonic J-pouch function at six months versus straight coloanal anastomosis at two years: randomized controlled trial.  World J Surg . 2001;  25 876-881
  • 64 Dehni N, Tiret E, Singland J. Long-term functional outcome after low anterior resection: comparison of low colorectal anastomosis and colonic J-pouch-anal anastomosis.  Dis Col Rectum . 1998;  47 817-822
  • 65 Ramirez J, Mortensen N, Takeuchi N, Humphreys S. Colonic J-pouch rectal reconstruction-Is it really a neorectum?.  Dis Colon Rectum . 1996;  39 1286-1288
  • 66 Hallbook O, Nystrom P, Sjodahl R. Physiologic characteristics of straight and colonic J-pouch anastomoses after rectal excision for cancer.  Dis Colon Rectum . 1997;  40 332-338
  • 67 Hallbook O, Sjodahl R. Comparison between the colonic J-pouch-anal anastomosis and healthy rectum: clinical and physiological function.  Br J Surg . 1997;  84 1437-1441
  • 68 Brown S, Seow-Choen F. Preservation of rectal function after low anterior resection with formation of a neorectum.  Semin Surg Oncol . 2000;  19 376-385
  • 69 Mortensen N, Ramirez J, Takeuchi N, Humphreys S. Colonic J-pouch-anal anastomosis after rectal excision for carcinoma: functional outcome.  Br J Surg . 1995;  82 611-613
  • 70 Hida J, Yasutomi M, Fujimoto K. Functional outcome after low anterior resection with low anastomosis for rectal cancer using the colonic J-pouch.  Dis Colon Rectum . 1996;  39 986-991
  • 71 Lazorthes F, Gamagami R, Chiotasso P, Istvan G, Muhammad S. Prospective, randomized study comparing clinical results between small and large colonic J-pouch following coloanal anastomosis.  Dis Col Rectum . 1997;  40 1409-1413
  • 72 Berger A, Tiret E, Parc R. Excision of the rectum with colonic J-pouch-anal anastomosis for adenocarcinoma of the low and mid rectum.  World J Surg . 1992;  16 470-477
  • 73 Hida J, Yasutomi M, Maruyama T, Tokoro T, Wakano T, Uchida T. Enlargement of colonic pouch after proctectomy and coloanal anastomosis: potential cause for evacuation difficulty.  Dis Colon Rectum . 1999;  42 1181-1188
  • 74 Seow-Choen F. Colonic pouches in the treatment of low rectal cancer.  Br J Surg . 1996;  83 881-882
  • 75 Heah S, Seow-Choen F, Eu K. Randomized trial using a sigmoid versus descending colonic J-pouch after ultralow anterior resection for rectal cancer: is there a difference. In press.  Dis Colon Rectum.
  • 76 Ikeuchi H, Kusukoki M, Shoji Y, Yamamura T, Utsunomita J. Functional results after ``high'' coloanal anastomosis and ``low'' coloanal anastomosis with a colonic J-pouch for rectal carcinoma.  Surg Today . 1997;  27 702-705
  • 77 Z'graggen K, Maurer C, Mettler D, Stoupis C, Wildi S, Buchler M. A novel colon pouch and its comparison with a straight coloanal and colo J-pouch-anal anastomosis: preliminary results in pigs.  Surgery . 1999;  125 105-112
  • 78 Z'graggen K, Maurer C, Buchler M. Transverse coloplasty pouch. A novel neorectal reservoir.  Dig Surg . 1999;  16 363-366
  • 79 Mantyh C, Hull T, Fazio V. Coloplasty in low colorectal anastomosis: manometric and functional comparison with straight and colonic J-pouch anastomosis.  Dis Colon Rectum . 2001;  44 37-42
  • 80 Maurer C, Z'graggen K, Zimmerman W, Hani H, Mettler D, Buchler M. Experimental study of neorectal physiology after formation of a transverse coloplasty pouch.  Br J Surg . 1999;  86 1451-1458.