Anoabdominal rectal resection and colonic J pouch-anal anastomosis: 10 years' experience

M Kusunoki, H Yanagi, Y Shoji, T Yamamura, J Utsunomiya
British Journal of Surgery 1997, 84 (9): 1277-80

BACKGROUND: Coloanal anastomosis and radiotherapy for the treatment of lower rectal carcinoma have been receiving increasing attention.

METHODS: Patients with rectal cancer were divided into two groups: anoabdominal rectal resection and colonic J pouch-anal anastomosis (CAA) plus preoperative intraluminal brachytherapy (IBT) (group 1; 68 patients) and CAA without IBT (group 2; 23 patients). Group 3, comprising 59 patients who underwent abdominoperineal excision (APE), was examined as a control group. Comparative results were reviewed.

RESULTS: Postoperative complications occurred more frequently in group 1 than in group 2. Actuarial 5-year survival rates were 73 per cent in group 1, 64 per cent in group 2 and 63 per cent in group 3. Cumulative local recurrence rates at 5 years were 11 per cent in group 1, 38 per cent in group 2 and 21 per cent in group 3. Intestinal continuity breakdown was seen in 14 per cent of all patients at 5 years after initial operation.

CONCLUSION: The combination of CAA and preoperative IBT resulted in decreased local recurrence. IBT followed by CAA can be a good restorative option for combating lower rectal cancer.

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