Clinical and Physiologic Anorectal Function after Low Anterior Resection in Patients with Rectal Cancer: A Prospective Randomized Comparison of Straight and Colonic J-Pouch Anastomoses

Purpose: The aim of this prospective study was to analyze anorectal physiologic and clinical outcomes of the colonic J-pouch -anal anastomosis compared with the traditional straight colorectal anastomosis after ultra -low anterior resection in patients with rectal cancer, thus to define if this method of modified reconstruction has a functional superiority. Methods: After total mesorectal excision for mid or low rectal cancers, patients were randomized to either a straight (n=23) or a colonic J-pouch anastomosis (n=24) to the lowermost rectum or anal canal. Functional outcomes were compared between two groups using an anorectal manometry performed before and 1 year after surgery and a bowel function questionnaire administered 6 months and 1 year postoperatively. Results: Except the arithmetic level of anastomosis which was significantly higher in straight group than in pouch group (5.11.2 cm vs. 3.80.9 cm; P=0.0001), the two groups were well matched for demographic distribution, pathologic stage, colonic segment used for neorectum and use of adjuvant therapies. Patients with colonic J-pouch anastomosis showed functional superiority in terms of frequency of bowel movements, degree of urgency at 6 months (P16.7 ml, which was significantly larger than that of 74.114.9 ml in straight group (P1.9 vs. 3.32.1; P