Functional outcome after coloanal versus low colorectal anastomosis for rectal carcinoma

The aim of this study was to compare retrospectively the longterm functional results of straight or J-pouch coloanal anastomosis and low colorectal anastomosis in patients operated for rectal carcinoma.

Of the 260 patients who underwent rectal resection for carcinoma in our department during a 12-year period, 105 were included in this study. Of these, 37 had straight coloanal, 15 J-pouch coloanal, and 53 low colorectal anastomoses.

At 1 year of followup, continence was significantly better after low colorectal than straight coloanal anastomosis (perfect continence: 81% versus 51%; p < 0.01). No significant difference was observed for continence after J-pouch coloanal and low colorectal anastomosis. Stool frequency during a 24-hour period was significantly higher after straight coloanal anastomosis than after either J-pouch coloanal (p < 0.05) or low colorectal anastomosis (p < 0.01). Night stools were significantly more frequent after straight than J-pouch coloanal anastomosis (p < 0.05). Three years after surgery, continence had improved in the three groups, as 70% of the straight coloanal group, 91% of the J-pouch coloanal group, and 94% of the colorectal anastomosis group had perfect continence (p < 0.02 versus straight coloanal anastomosis). No significant difference for continence was observed between the J-pouch coloanal and low colorectal anastomosis groups. Neither were significant differences observed among the three groups for urgency, gas/stool discrimination, stool frequency (including night stools), or the need for medication.

The functional results of both J-pouch coloanal and low stapled colorectal anastomosis seem better than those of straight coloanal anastomosis. Both J-pouch and low-stapled procedures can safely be proposed for patients with rectal carcinoma requiring total mesorectal rectal excision; however, because low stapled colorectal anastomosis seems to us easier and faster to perform, we consider it the best option for rectal reconstruction after proctectomy for carcinoma, provided it is possible based on the level of the tumor.