2000 Abstract: 2396: Prospective Assessment of Functional Results After Proctectomy with Coloanal Anastomosis.
Abstracts
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Objective: To assess the functional results after restorative proctectomy with coloanal anastomosis for rectal cancer. Materials and Methods: Thirty consecutive patients (mean age 59.6 + 9.8, range 40-75, 18 males) undergoing a proctectomy with coloanal anastomosis for rectal cancer between 1/90 and 3/97 were evaluated using a prospective, patient completed protocol to record their bowel activity daily over one week at 3, 6, 12 mo and yearly thereafter. Mean follow-up was 43 mo., range 3-96 mo. Results: There were no perioperative deaths. Four patients developed a clinically evident anastomotic dehiscence. Overall, stool frequency decreased from 4.4 ± 2.5 bms/day at 3 mo to 3.0 ± 2.7 bms/day at five years, without urgency. The percentage of continent patients increased from 50% at six mo to 75% at five years; the percentage of patients with incontinence to solid stool decreased from 35.7% at six mo to 12.5% at five years. The influence of the type of anastomosis (handsewn 6; stapled 24), dehiscence (yes 4; no 26), protective stoma (yes 22; no 8), J-pouch (yes 11; no 19), radiation therapy (preoperative 12; postoperative 6) and gender (18 males, 12 females) was evaluated with univariate analysis. The occurrence of an anastomotic dehiscence increased the number of episodes of incontinence/ wk at 6 mo, 2 and 5 yr (p<0.05) and the number of episodes of incontinence for solid stools at 6 mo, 2 and 5 yr. (p<0.001). The use of preoperative radiation therapy increased the number of episodes of incontinence/ wk at 6 mo, 1, 2 and 5 yr (p<0.01) and the number of episodes of incontinence for solid stools at 3 and 6 mo, 1 and 2 yr. (p<0.02, 0.03, 0.03 and 0.04 respectively). Patients with a J-pouch had a lower stool frequency in comparison to patients with an end to end coloanal anastomosis during the entire study period (from 3.2 ± 2.2 vs. 3.9 ± 2.7 bms/day at 6 mo to 2.8 ± 1.9 vs 3.4 ± 4.0 bms/day at 5 yr., no statistical significance), an increase in the number of episodes of incontinence/wk at 1 and 2 yr (p<0.03 and 0.005 respectively) and an increase in the number of episodes of incontinence for solid stools at 2, 3 and 4 yr. (p<0.05). Conclusions: These data suggest that the functional results after a proctectomy with coloanal anastomosis are negatively impacted by the occurrence of an anastomotic dehiscence and the use of preoperative radiation therapy. Furthermore, functional results significantly improve over the first five years after surgery. The long term benefit on functional results derived by adding a colonic J pouch are not well established. |
