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A meta-analysis comparing side to end with colonic J-pouch formation after anterior resection for rectal cancer

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Abstract

Background

A meta-analysis of published literature comparing J-pouch with side to end anastomosis after anterior resection (AR) for rectal cancer.

Methods

Electronic databases were searched from January 1980 to March 2009. A systematic review was performed to obtain a summative outcome.

Results

Four randomized controlled trials involving 273 patients were analysed. One hundred and thirty-eight patients were in the J-pouch and 135 in the side to end anastomosis (STEA) group. No significant difference in surgically related outcomes was established (hospital stay, operative time, estimated blood loss, overall morbidity and mortality). Resting pressures at 24 months post-operatively were lower in J-pouch group compared with STEA and approached statistical significance [random effects model: SMD = −1.23, 95% CI (−2.47, −0.01), z = −1.94, P = 0.053]. No statistical difference was found in volumetric parameters (Volume at which the patient first experiences a sensation to defaecate and maximal tolerable volume). No statistical difference except urgency at 6 months [P < 0.05] was elicited in functional outcomes (use of enemas, bowel medications, pads, incomplete defaecation and stool frequency) between J-pouch and STEA groups.

Conclusions

J-pouch or STEA are acceptable and safe options after AR for rectal cancer. Either approach may be considered according to surgeon choice. A randomized controlled trial including a larger number of patients is required to strengthen the evidence.

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References

  1. Williams NS (1984) The rationale for preservation of the anal sphincter in patients with low rectal cancer. Br J Surg 71:575–581

    Article  CAS  PubMed  Google Scholar 

  2. Dehni N, Tiret E, Singland JD et al (1998) Long-term functional outcome after low anterior resection: comparison of low colorectal anastomosis and colonic J-pouch-anal anastomosis. Dis Colon Rectum 41:817–822, discussion 22-23

    Google Scholar 

  3. Ortiz H, De Miguel M, Armendariz P, Rodriguez J, Chocarro C (1995) Coloanal anastomosis: are functional results better with a pouch? Dis Colon Rectum 38:375–377

    Article  CAS  PubMed  Google Scholar 

  4. Limbosch JM, Druart ML, Blondiau J, Blairon J (1986) Analysis of 66 cases of colorectal side-to-end anastomosis by the Baker method. Acta Chir Belg 86:216–221

    CAS  PubMed  Google Scholar 

  5. Harris GJ, Lavery IJ, Fazio VW (2002) Reasons for failure to construct the colonic J-pouch. What can be done to improve the size of the neorectal reservoir should it occur? Dis Colon Rectum 45:1304–1308

    Article  CAS  PubMed  Google Scholar 

  6. Paty PB, Enker WE, Cohen AM, Minsky BD, Friederlander-Klar H (1994) Long-term functional results of coloanal anastomosis for rectal cancer. Am J Surg 167:90–95

    Article  CAS  PubMed  Google Scholar 

  7. Ho YH, Brown S, Heah SM et al (2002) Comparison of J-pouch and coloplasty pouch for low rectal cancers: a randomized, controlled trial investigating functional results and comparative anastomotic leak rates. Ann Surg 236:49–55

    Article  PubMed  Google Scholar 

  8. Otto S, Kroesen AJ, Hotz HG, Buhr HJ, Kruschewski M (2008) Effect of anastomosis level on continence performance and quality of life after colonic J-pouch reconstruction. Dig Dis Sci 53:14–20

    Article  PubMed  Google Scholar 

  9. Zehnder MA (1968) 2 variations of the sigmoid-rectum resection suture. I. Side-to-end anastomosis of the sigmoid-rectum. II. Extraperitoneal transposition of the colonic resection suture. Helv Chir Acta 35:526–534

    CAS  PubMed  Google Scholar 

  10. Nakada I, Kawasaki S, Sonoda Y, Watanabe Y, Tabuchi T (2004) Abdominal stapled side-to-end anastomosis (Baker type) in low and high anterior resection: experiences and results in 69 consecutive patients at a regional general hospital in Japan. Colorectal Dis 6:165–170

    Article  CAS  PubMed  Google Scholar 

  11. Schima E (1968) Side-to-end or end-to-end anastomosis in the anterior resection of the rectosigmoid? Bruns Beitr Klin Chir 216:501–503

    CAS  PubMed  Google Scholar 

  12. Machado M, Nygren J, Goldman S, Ljungqvist O (2003) Similar outcome after colonic pouch and side-to-end anastomosis in low anterior resection for rectal cancer: a prospective randomized trial. Ann Surg 238:214–220

    PubMed  Google Scholar 

  13. Hallböök O, Nystrom PO, Sjodahl R (1997) Physiologic characteristics of straight and colonic J-pouch anastomoses after rectal excision for cancer. Dis Colon Rectum 40:332–338

    Article  PubMed  Google Scholar 

  14. Egger M, Smith GD, Altman DG (2006) Systematic reviews in healthcare. BMJ Publishing, London

    Google Scholar 

  15. Deeks JJ, Altman DG, Bradburn MJ (2001) Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Group BP (ed) Systematic reviews in health care: meta-analysis in context, 2nd edn. BMJ Publication group, London

    Google Scholar 

  16. Machado M, Nygren J, Goldman S, Ljungqvist O (2005) Functional and physiologic assessment of the colonic reservoir or side-to-end anastomosis after low anterior resection for rectal cancer: a two-year follow-up. Dis Colon Rectum 48:29–36

    Article  PubMed  Google Scholar 

  17. Jiang JK, Yang SH, Lin JK (2005) Transabdominal anastomosis after low anterior resection: A prospective, randomized, controlled trial comparing long-term results between side-to-end anastomosis and colonic J-pouch. Dis Colon Rectum 48:2100–2108; discussion 8-10

    Google Scholar 

  18. Huber FT, Herter B, Siewert JR (1999) Colonic pouch vs. side-to-end anastomosis in low anterior resection. Dis Colon Rectum 42:896–902

    Article  CAS  PubMed  Google Scholar 

  19. Prete F, Liguori P, Nitti P, Vincenti L, Prete FP (2000) Optimal reconstruction after resection of the rectum in cancer surgery. Chir Ital 52:323–328

    CAS  PubMed  Google Scholar 

  20. Furst A, Burghofer K, Babl-Weisbarth M, Kummel S, Tange S, Jauch KW (1998) Functional outcome and quality of life after coloanal or colonic pouch-anal anastomosis–a prospective randomized study. Langenbecks Arch Chir Suppl Kongressbd 115:621–624

    CAS  PubMed  Google Scholar 

  21. Heriot AG, Tekkis PP, Constantinides V et al (2006) Meta-analysis of colonic reservoirs versus straight coloanal anastomosis after anterior resection. Br J Surg 93:19–32

    Article  CAS  PubMed  Google Scholar 

  22. Sailer M, Debus ES, Fuchs KH, Beyerlein J, Thiede A (2000) Comparison of anastomotic microcirculation in coloanal J-pouches versus straight and side-to-end coloanal reconstruction: an experimental study in the pig. Int J Colorectal Dis 15:114–117

    Article  CAS  PubMed  Google Scholar 

  23. Sailer M, Debus ES, Fuchs KH, Fein M, Beyerlein J, Thiede A (1999) Comparison of different J-pouches vs. straight and side-to-end coloanal anastomoses: experimental study in pigs. Dis Colon Rectum 42:590–595

    Article  CAS  PubMed  Google Scholar 

  24. Simillis C, Purkayastha S, Yamamoto T, Strong SA, Darzi AW, Tekkis PP (2007) A meta-analysis comparing conventional end-to-end anastomosis vs. other anastomotic configurations after resection in Crohn’s disease. Dis Colon Rectum 50:1674–1687

    Article  PubMed  Google Scholar 

  25. Willis S, Holzl F, Wein B, Tittel A, Schumpelick V (2007) Defecation mechanisms after anterior resection with J-pouch-anal and side-to-end anastomosis in dogs. Int J Colorectal Dis 22:161–165

    Article  CAS  PubMed  Google Scholar 

  26. Rangel SJ, Kelsey J, Colby CE, Anderson J, Moss RL (2003) Development of a quality assessment scale for retrospective clinical studies in pediatric surgery. J Pediatr Surg 38:390–396

    Article  PubMed  Google Scholar 

  27. SIGN guidelines. [cited 20th March 2009]; available from: http://www.sign.ac.uk/guidelines/fulltext/50/checklist3

  28. Chalmers TC, Smith H Jr, Blackburn B et al (1981) A method for assessing the quality of a randomized control trial. Control Clin Trials 2:31–49

    Article  CAS  PubMed  Google Scholar 

  29. Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12

    Article  CAS  PubMed  Google Scholar 

  30. Association of Coloproctology of Great Britain and Ireland. Guidance for the management of colorectal cancer. London: Royal College of Surgeons of England 2007

  31. Dehni N, Schlegel D, Tiret E, Singland JD, Guiguet M, Parc R (1998) Effects of aging on the functional outcome of coloanal anastomosis with colonic J-pouch. Am J Surg 175:209–212

    Article  CAS  PubMed  Google Scholar 

  32. 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 73:136–138

    Article  CAS  PubMed  Google Scholar 

  33. 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 73:139–141

    Article  CAS  PubMed  Google Scholar 

  34. Chung CC, Ha JP, Tsang WW, Li MK (2001) Laparoscopic-assisted total mesorectal excision and colonic J pouch reconstruction in the treatment of rectal cancer. Surg Endosc 15:1098–1101

    Article  CAS  PubMed  Google Scholar 

  35. Baker JW (1950) Low end to side recto-sigmoidal anastomosis. Description of technic. Arch Surg 61:143–157

    CAS  PubMed  Google Scholar 

  36. Adloff M, Arnaud JP, Beeharry S, Turbelin JM (1980) Side-to-end anastomosis in low anterior resection with the EEA stapler. Dis Colon Rectum 23:456–458

    Article  CAS  PubMed  Google Scholar 

  37. Julian TB, Wolmark N (1990) Stapled Baker type anastomosis for low anterior resections. Surg Gynecol Obstet 171:169–170

    CAS  PubMed  Google Scholar 

  38. Yamamura T, Akaishi O, Tsukikawa S (1997) Intra-abdominal side-to-end stapling technique for anterior resection of rectal cancer. J Surg Oncol 66:139–140

    Article  CAS  PubMed  Google Scholar 

  39. Fazio VW, Zutshi M, Remzi FH et al (2007) A randomized multicenter trial to compare long-term functional outcome, quality of life, and complications of surgical procedures for low rectal cancers. Ann Surg 246:481–490

    Article  PubMed  Google Scholar 

  40. Quill JR (1978) Side-to-end colorectal anastomosis with monofilament stainless steel wire. Arch Surg 113:1205–1208

    CAS  PubMed  Google Scholar 

  41. Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M (1998) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85:355–358

    Article  CAS  PubMed  Google Scholar 

  42. West AB, NDSG (2008) The pathology of diverticulitis. J Clin Gastroenterol 42:1137–1138

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Colorectal Surgery, Worthing Hospital, Washington Suite, North Wing, Worthing, West Sussex, BN11 2DH, UK

    M. R. S. Siddiqui, M. S. Sajid, W. G. A. Woods, E. Cheek & M. K. Baig

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  1. M. R. S. Siddiqui
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  2. M. S. Sajid
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  3. W. G. A. Woods
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  4. E. Cheek
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Correspondence to M. R. S. Siddiqui.

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Siddiqui, M.R.S., Sajid, M.S., Woods, W.G.A. et al. A meta-analysis comparing side to end with colonic J-pouch formation after anterior resection for rectal cancer. Tech Coloproctol 14, 113–123 (2010). https://doi.org/10.1007/s10151-010-0576-1

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  • DOI: https://doi.org/10.1007/s10151-010-0576-1

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