Abstract
Purpose
This is a meta-analysis of randomized, controlled trials to compare the function and complications of a straight coloanal anastomosis to a colonic J-pouch after rectal excision at 1 year postoperatively.
Materials and methods
A search for articles from 1980 to 2005 was conducted on Medline, PubMed, and the Cochrane Controlled Trials Register using the keywords “colonic pouches, J-pouch, straight and coloanal anastomosis, rectal cancer, function and complications,” either singularly or in combination. Reference lists from short-listed articles were also manually searched for relevant articles, journals, and conference proceedings. Randomized controlled trials (RCTs) in English publications comparing colonic J-pouches to straight coloanal anastomosis were selected. Trials with similar patient characteristics, duration of follow-up, and outcome measures were pooled for analysis. Stool frequency and fecal continence at 1 year postoperatively were used as measures of functional outcome. Complication rates in terms of anastomotic leak and stricture formation were analysed.
Results
Ten RCTs with satisfactory methodology were identified. One trial reported the results at 2 years, while another reported results at 5 years only and were excluded from the meta-analysis, leaving only eight studies for further analysis. Overall, a colonic J-pouch appeared more favorable in terms of stool frequency (weighted mean difference of −1.21, 95% CI: −1.92 to −0.49) and continence (Odds ratio 0.23, 95% CI: 0.08–0.69), with a slightly lower risk of anastomotic dehiscence compared to a straight coloanal anastomosis (relative risk, RR 0.36; 95% CI: 0.12–1.08). Anastomotic stricture was reported in only two trials. They seemed more likely to occur after a pouch-anal anastomosis (RR 2.45, 95% CI: 0.79–7.57). However, the small numbers available for pooled analysis cannot allow these conclusions to be drawn with confidence.
Conclusions
A straight coloanal anastomosis resulted in poorer function due to loss of a rectal reservoir, while colonic J-pouches have improved frequency and continence up to a year. Although retrospective reports seem to favor the use of a pouch, there are limited longer term randomized trial data to suggest that the function and complications of a coloanal J-pouch is better than a straight coloanal anastomosis. Larger randomized studies are required to further verify the longer-term benefits of a coloanal pouch.
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References
Lazorthes F, Fages P, Chiotasso P, Lemozy J, Bloom E (1986) Resection of the rectum with construction of a colonic reservoir and colo-anal anastomosis for carcinoma of the rectum. Br J Surg 73(2):136–138
Parc R, Tiret E, Frileux P, Moszkowski E, Loygue J (1986) Resection and colo-anal anastomosis with colonic reservoir for rectal carcinoma. Br J Surg 73(2):139–141
Moher D, Schulz KF, Altman DG (2001) The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. Ann Intern Med 134(8):657–662
Ho YH, Seow-Choen F, Tan M (2001) Colonic J-pouch function at six months versus straight coloanal anastomosis at two years: randomized controlled trial. World J Surg 25(7):876–881
Hida J, Yoshifuji T, Tokoro T, Inoue K, Matsuzaki T, Okuno K, Shiozaki H, Yasutomi M (2004) Comparison of long-term functional results of colonic J-pouch and straight anastomosis after low anterior resection for rectal cancer: a five-year follow-up. Dis Colon Rectum 47(10):1578–1585
Sailer M, Fuchs KH, Fein M, Thiede A (2002) Randomized clinical trial comparing quality of life after straight and pouch coloanal reconstruction. Br J Surg 89(9):1108–1117
Furst A, Burghofer K, Hutzel L, Jauch KW (2002) Neorectal reservoir is not the functional principle of the colonic J-pouch: the volume of a short colonic J-pouch does not differ from a straight coloanal anastomosis. Dis Colon Rectum 45(5):660–667
Seow-Choen F, Goh HS (1995) rospective randomized trial comparing J colonic pouch-anal anastomosis and straight coloanal reconstruction. Br J Surg 82(5):608–610
Oya M, Komatsu J, Takase Y, Nakamura T, Ishikawa H (2002) Comparison of defecatory function after colonic J-pouch anastomosis and straight anastomosis for stapled low anterior resection: results of a prospective randomized trial. Surg Today 32(2):104–110
Hallbook O, Pahlman L, Krog M, Wexner SD, Sjodahl R (1996) Randomized comparison of straight and colonic J pouch anastomosis after low anterior resection. Ann Surg 224(1):58–65
Ho YH, Tan M, Seow-Choen F (1996) Prospective randomized controlled study of clinical function and anorectal physiology after low anterior resection: comparison of straight and colonic J pouch anastomoses. Br J Surg 83(7):978–980
Ho YH, Yu S, Ang ES, Seow-Choen F, Sundram F (2002) Small colonic J-pouch improves colonic retention of liquids-randomized, controlled trial with scintigraphy. Dis Colon Rectum 45(1):76–82
Lazorthes F, Chiotasso P, Gamagami RA, Istvan G, Chevreau P (1997) Late clinical outcome in a randomized prospective comparison of colonic J pouch and straight coloanal anastomosis. Br J Surg 84(10):1449–1451
Hallbook O, Johansson K, Sjodahl R (1996) Laser doppler blood flow measurement in rectal resection for carcinoma - comparison between straight and colonic pouch. Br J Surg 83:389–392
Heah SM, Seow-Choen F, Eu KW, Ho YH, Tang CL (2002) Prospective, randomized trial comparing sigmoid vs. descending colonic J-pouch after total rectal excision. Dis Colon Rectum 45(3):322–328
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Koh, PK., Tang, CL., Eu, KW. et al. A systematic review of the function and complications of colonic pouches. Int J Colorectal Dis 22, 543–548 (2007). https://doi.org/10.1007/s00384-006-0187-5
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DOI: https://doi.org/10.1007/s00384-006-0187-5