[Total mesorectal excison and colonic-J-pouch-anal anastomosis in the therapy of low rectal carcinoma—results in 116 patients]

A Ommer, M Girona-Johannkemper, K-P Jung, E Berg
Zentralblatt Für Chirurgie 2002, 127 (9): 775-80

BACKGROUND: Total mesorectal excision with coloanal anastomosis has been accepted as standard therapy of low rectal carcinoma. Interposition of colonic J-pouch improved the functional results and was associated with better postoperative quality of life. In this study our own results are evaluated.

METHODS: Between 1. 7. 1999 and 30. 6. 2001 116 patients underwent total mesorectal excision with coloanal anastomosis and colonic J-pouch interposition. Thirty-eight patients (32.9 %) with uT3-carcinoma received preoperative adjuvant short-time irradiation with 5 x 5 Gy and seven patients (6.0 %) with local non resectable cancer conventional radiochemotherapy with 50.4 Gy. A protective stoma was constructed in 56 patients (48.3 %). Six patients (5.2 %) received secondary stoma due to anastomotic complications.

RESULTS: A clinically relevant insufficiency of the anastomosis occurred in eight patients (6.9 %). Three patients needed a secondary laparotomy for local peritonitis. Fecal diversion was constructed secondarily in four patients due to pouchvaginal fistula and in one patient for ischiorectal abscess one year after the first operation. Six patients revealed small fistulas in the radiological examination without clinical consequences. Five patients with primary fecal diversion showed pouchvaginal fistulas. The over-all anastomotic complication rate was 16.4 %. The follow-up demonstrated already in the first year after surgery good functional results with satisfying anorectal continence. Only nine patients complained of intermittent incontinence for solid stool. No patient needed a definitive stoma due to anastomotic complications. One patient developed a small anastomotic tumor recurrence one year after surgery. He could be cured by abdomino-perineal excision.

CONCLUSIONS: Our results confirm the importance of total mesorectal excision as standard therapy for low rectal carcinoma. Good functional results can be obtained already in the early postoperative period by colonic J-pouch interposition.

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