AIM:There is some evidence of functional superiority of colonic J-pouch over straight coloanal anastomosis (CM) in ultralow anterior resection (ULAR) or intersphincteric resection. On the assumption that colonic J-pou...AIM:There is some evidence of functional superiority of colonic J-pouch over straight coloanal anastomosis (CM) in ultralow anterior resection (ULAR) or intersphincteric resection. On the assumption that colonic J-pouch anal anastomosis is superior to straight CM in ULAR with upper sphincter excision (USE: excision of the upper part of the internal sphincter) for low-lying rectal cancer, we compare functional outcome of colonic J-pouch vsthe straight CM. METHODS: Fifty patients of one hundred and thirty-three rectal cancer patients in whom lower margin of the tumors were located between 3 and 5 cm from the anal verge received ULAR including USE from September 1998 to January 2002. Patients were randomized for reconstruction using either a straight (n = 26) or a colonic J-pouch anastomosis (n = 24) with a temporary diverting-loop ileostomy. All patients were followed-up prospectively by a standardized questionnaire [Fecal Inco-ntinence Severity Index (FISI) scores and Fecal Incontinence Quality of Life (FIQL) scales]. RESULTS: We found that, compared to straight anastomosis patients, the frequency of defecation was significantly lower in J-pouch anastomosis patients for 10 mo after ileostomy takedown. The FISI scores and FIQL scales were significantly better in J-pouch patients than in straight patients at both 3 and 12 mo after ileostomy takedown. Furthermore, we found that FISI scores highly correlated with FIQL scales. CONCLUSION: This study indicates that colonic J-pouch anal anastomosis decreases the severity of fecal incontinence and improves the quality of life for 10 mo after ileostomy takedown in patients undergoing ULAR with USE for low-lying rectal cancer.展开更多
To assess the merits of currently available treatment options in the management of patients with low rectal cancer, a review of the medical literature pertaining to the operative and non-operative management of low re...To assess the merits of currently available treatment options in the management of patients with low rectal cancer, a review of the medical literature pertaining to the operative and non-operative management of low rectal cancer was performed, with particular emphasis on sphincter preservation, oncological outcome, functional outcome, morbidity, quality of life, and patient preference. Low anterior resection (AR) is technically feasible in an increasing proportion of patients with low rectal cancer. The cost of sphincter preservation is the risk of morbidity and poor functional outcome in a significant proportion of patients. Transanal and endoscopic surgery are attractive options in selected patients that can provide satisfactory oncological outcomes while avoiding the morbidity and functional sequelae of open total mesorectal excision. In complete responders to neo-adjuvant chemoradiotherapy, a non-operative approach may prove to be an option. Abdominoperineal excision (APE) imposes a permanent stoma and is associated with significant incidence of perineal morbidity but avoids the risk of poor functional outcome following AR. Quality of life following AR and APE is comparable. Given the choice, most patients will choose AR over APE, however patients following APE positively appraise this option. In striving toward sphincter preservation the challenge is not only to achieve the best possible oncological outcome, but also to ensure that patients with low rectal cancer have realistic and accurate expectations of their treatment choice so that the best possible overall outcome can be obtained by each individual.展开更多
OBJECTIVE To assess the use of gluteus maximus muscle to recon- struct the anal sphincter for very low rectal cancer. This study aimed to evaluate the local recurrence and function of the new anal sphincter after oper...OBJECTIVE To assess the use of gluteus maximus muscle to recon- struct the anal sphincter for very low rectal cancer. This study aimed to evaluate the local recurrence and function of the new anal sphincter after operation. METHODS Sixteen patients underwent the replacement operation, and then received biofeedback treatments 1 month after the operation. The therapeutic responses were evaluated using the Vaizey and Wexner scoring systems and vectorial manometry. The controls were 30 cases who had undergone a low anterior resection for rectal cancer and 30 healthy people. RESULTS Median follow-up was 4.2 years. No local recurrence was observed. The Vaizey and Wexner scores and vectorial manometry 1 month after operation were significantly lower than those of the healthy and low anterior resection controls （ P 〈0.001） . After biofeedback treatments, the above indexes improved significantly （ P 〈0.001）, especially after 1 year （ P 〈0.001）, but still remained lower than the controls（ P 〈0.001）. The rectoanal reflex only increased to 31.3 % 1 year after operation. CONCLUSION The local recurrence after the replacement operation was low. The defecation function was poor early after operation, but increased markedly after biofeedback treatments and long-term functional exercise. This therapy can be one choice for very low rectal cancer.展开更多
文摘AIM:There is some evidence of functional superiority of colonic J-pouch over straight coloanal anastomosis (CM) in ultralow anterior resection (ULAR) or intersphincteric resection. On the assumption that colonic J-pouch anal anastomosis is superior to straight CM in ULAR with upper sphincter excision (USE: excision of the upper part of the internal sphincter) for low-lying rectal cancer, we compare functional outcome of colonic J-pouch vsthe straight CM. METHODS: Fifty patients of one hundred and thirty-three rectal cancer patients in whom lower margin of the tumors were located between 3 and 5 cm from the anal verge received ULAR including USE from September 1998 to January 2002. Patients were randomized for reconstruction using either a straight (n = 26) or a colonic J-pouch anastomosis (n = 24) with a temporary diverting-loop ileostomy. All patients were followed-up prospectively by a standardized questionnaire [Fecal Inco-ntinence Severity Index (FISI) scores and Fecal Incontinence Quality of Life (FIQL) scales]. RESULTS: We found that, compared to straight anastomosis patients, the frequency of defecation was significantly lower in J-pouch anastomosis patients for 10 mo after ileostomy takedown. The FISI scores and FIQL scales were significantly better in J-pouch patients than in straight patients at both 3 and 12 mo after ileostomy takedown. Furthermore, we found that FISI scores highly correlated with FIQL scales. CONCLUSION: This study indicates that colonic J-pouch anal anastomosis decreases the severity of fecal incontinence and improves the quality of life for 10 mo after ileostomy takedown in patients undergoing ULAR with USE for low-lying rectal cancer.
文摘To assess the merits of currently available treatment options in the management of patients with low rectal cancer, a review of the medical literature pertaining to the operative and non-operative management of low rectal cancer was performed, with particular emphasis on sphincter preservation, oncological outcome, functional outcome, morbidity, quality of life, and patient preference. Low anterior resection (AR) is technically feasible in an increasing proportion of patients with low rectal cancer. The cost of sphincter preservation is the risk of morbidity and poor functional outcome in a significant proportion of patients. Transanal and endoscopic surgery are attractive options in selected patients that can provide satisfactory oncological outcomes while avoiding the morbidity and functional sequelae of open total mesorectal excision. In complete responders to neo-adjuvant chemoradiotherapy, a non-operative approach may prove to be an option. Abdominoperineal excision (APE) imposes a permanent stoma and is associated with significant incidence of perineal morbidity but avoids the risk of poor functional outcome following AR. Quality of life following AR and APE is comparable. Given the choice, most patients will choose AR over APE, however patients following APE positively appraise this option. In striving toward sphincter preservation the challenge is not only to achieve the best possible oncological outcome, but also to ensure that patients with low rectal cancer have realistic and accurate expectations of their treatment choice so that the best possible overall outcome can be obtained by each individual.
基金This work was supported by a grant from thUniversity Science and Technique ResearcProgram of the Education Department of Liaoning Province(No.05L484)
文摘OBJECTIVE To assess the use of gluteus maximus muscle to recon- struct the anal sphincter for very low rectal cancer. This study aimed to evaluate the local recurrence and function of the new anal sphincter after operation. METHODS Sixteen patients underwent the replacement operation, and then received biofeedback treatments 1 month after the operation. The therapeutic responses were evaluated using the Vaizey and Wexner scoring systems and vectorial manometry. The controls were 30 cases who had undergone a low anterior resection for rectal cancer and 30 healthy people. RESULTS Median follow-up was 4.2 years. No local recurrence was observed. The Vaizey and Wexner scores and vectorial manometry 1 month after operation were significantly lower than those of the healthy and low anterior resection controls （ P 〈0.001） . After biofeedback treatments, the above indexes improved significantly （ P 〈0.001）, especially after 1 year （ P 〈0.001）, but still remained lower than the controls（ P 〈0.001）. The rectoanal reflex only increased to 31.3 % 1 year after operation. CONCLUSION The local recurrence after the replacement operation was low. The defecation function was poor early after operation, but increased markedly after biofeedback treatments and long-term functional exercise. This therapy can be one choice for very low rectal cancer.
