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J-pouch vs side-to-end coloanal anastomosis after preoperative radiotherapy and total mesorectal excision for rectal cancer: a multicentre randomized trial.
- Source :
-
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Colorectal Dis] 2012 Jun; Vol. 14 (6), pp. 705-13. - Publication Year :
- 2012
-
Abstract
- Aim: Comparison of functional and surgical outcome of the J-pouch with the side-to-end coloanal anastomosis after preoperative radiotherapy and total mesorectal excision in rectal cancer patients.<br />Method: In a multicentre study, patients with a carcinoma of the lower two-thirds of the rectum were randomized to either a J-pouch or a side-to-end reconstruction. Primary outcome was function of the neorectum 1 year after surgery. A functional outcome [COloREctal Functional Outcome (COREFO)] questionnaire, and two quality of life questionnaires (EORTC-QLQ-CR38 and SF-36) were to be completed by all participants preoperatively, and 4 and 12 months postoperatively. Independent data managers recorded surgical outcome. A group size of 30 patients in each group was calculated based on a 15-point difference of the COREFO scale.<br />Results: In total, 107 patients were randomized, 55 in the J-pouch group and 52 in the side-to-end anastomosis group. The COREFO incontinence scale at 4 months and the total functional outcome at 4 and 12 months showed better results for the J-pouch group in comparison with the side-to-end anastomosis group. The remaining COREFO scales (frequency, social impact, stool-related aspects and bowel medication), surgical outcome (complications, reoperations, length of hospital stay, readmissions and mortality) and quality of life did not show significant differences between treatment groups.<br />Conclusion: The overall results of a coloanal J-pouch and a side-to-end anastomosis are comparable, although functional results are slightly better with a J-pouch. The side-to-end anastomosis is technically less demanding and therefore a justified alternative in sphincter-saving surgery.<br /> (© 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Anal Canal physiology
Anastomosis, Surgical
Carcinoma radiotherapy
Colon physiology
Fecal Incontinence etiology
Female
Humans
Male
Middle Aged
Neoadjuvant Therapy
Organ Sparing Treatments
Quality of Life
Rectal Neoplasms radiotherapy
Severity of Illness Index
Statistics, Nonparametric
Surveys and Questionnaires
Anal Canal surgery
Carcinoma surgery
Colon surgery
Colonic Pouches physiology
Rectal Neoplasms surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1463-1318
- Volume :
- 14
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
- Publication Type :
- Academic Journal
- Accession number :
- 21831100
- Full Text :
- https://doi.org/10.1111/j.1463-1318.2011.02725.x