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Evidence summaries

Reconstructive Techniques after Rectal Resection for Rectal Cancer

After low anterior resection for rectal cancer, coloanal reconstruction with the colonic J pouch leads to better bowel function up to 18 months postoperatively and similar rates of postoperative complications when compared to the straight coloanal anastomosis. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 16 studies with a total of 2 609 subjects. 9 studies (n=473) compared straight coloanal anastomosis (SCA) to the colonic J pouch (CJP). Up to 18 months postoperatively, the CJP was superior to SCA in most studies in bowel frequency, urgency, fecal incontinence and use of antidiarrheal medication. There were too few patients with long-term bowel function outcomes to determine if this advantage continued after 18 months postoperatively. 4 studies (n=215) compared the side-to-end anastomosis (STE) to the CJP. These studies showed no difference in bowel function outcomes between these two techniques. Similarly, 3 studies (n=158) compared transverse coloplasty (TC) to CJP, and there were no differences in bowel function outcomes in these small studies. Overall, there were no significant differences in postoperative complications with any of the anastomotic strategies.

Comment: The quality of evidence is downgraded by study quality (lack of blinding and unclear intention-to-treat adherence).

    References

    • Brown CJ, Fenech DS, McLeod RS. Reconstructive techniques after rectal resection for rectal cancer. Cochrane Database Syst Rev 2008 Apr 16;(2):CD006040. [PubMed]

Primary/Secondary Keywords