Functional results after TME: J-pouch vs straight coloanal anastomosis and role of neoadjuvant radiochemotherapy

Abstract

AIM: Purpouse of this study was to evaulate short and long term funtional outcomes after TME (total mesorectal excision) for rectal cancer. The role of straight anastomosis or colonic J-pouch reconstruction is investigated, as well as the impact of preoperative chemoradiotherapy is analyzed as a cause of the so called “anterior resection syndrome”. 

METHODS: We enrolled 40 patients (17 male and 23 female), in which a low anterior resection was performed: they were divided in four groups: A1 (Straight and no RCT), A2 (Straight and RCT), B1 (J-pouch and no RCT), B2 (Jpouch and RCT). Follow-up was performed six and twelve months after surgery, through a clinical questionnaire ( to assess: stool frequency, incomplete emptying, the presence of fecal leakage, urgency and incontinence ) and through anorectal manometry ( to assess rest pressure, squeeze pressure, max tolerated volume and compliance). Results were evaluated through T-Student and Chi-Squared test. 

RESULTS: Six months after surgery, colonic J-pouch offers the best clinical and functional results, in both radiated and not radiated patients (except for incomplete emptying); in the straight group, however, there is an improvement of results after twelve months. Chemoradiation therapy is always associated with worse functional results. 

DISCUSSION: RCT seems to invalidate J-pouch function in particular, in fact twelve months after surgery the difference between J-Pouch and Straight groups is not statistically different for most of the parameters. 

CONCLUSION: J-pouch gives a real functional advantage for only six months after surgery, especially in patients treated with neoajuvant chemoradiation therapy.