Intervention Review

Reconstructive Techniques After Rectal Resection for Rectal Cancer

  1. Carl J Brown1,*,
  2. Darlene Fenech2,
  3. Robin S McLeod3

Editorial Group: Cochrane Colorectal Cancer Group

Published Online: 23 APR 2008

Assessed as up-to-date: 28 NOV 2007

DOI: 10.1002/14651858.CD006040.pub2

How to Cite

Brown CJ, Fenech D, McLeod RS. Reconstructive Techniques After Rectal Resection for Rectal Cancer. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD006040. DOI: 10.1002/14651858.CD006040.pub2.

Author Information

  1. 1

    University of Toronto, Surgery, Toronto, Ontario, Canada

  2. 2

    Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada

  3. 3

    Mount Sinai Hospital, Division of General Surgery, Toronto, Ontario, Canada

*Carl J Brown, Surgery, University of Toronto, 449-600 University Avenue, Toronto, Ontario, M5G 1X5, Canada.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 APR 2008




  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要


Total mesorectal resection (TME) has led to improved survival and reduced local recurrence in patients with rectal cancer. Straight coloanal anastomosis after TME can lead to problems with frequent bowel movements, fecal urgency and incontinence. The colonic J pouch, side-to-end anastomosis and transverse coloplasty have been developed as alternative surgical strategies in order to improve bowel function.


The purpose of this study is to determine which rectal reconstructive technique results in the best postoperative bowel function.

Search methods

A systematic search of the literature (MEDLINE, Cancerlit, Embase and Cochrane Databases) was conducted from inception to Feb 14, 2006 by two independent investigators.

Selection criteria

Randomized controlled trials in which patients with rectal cancer undergoing low rectal resection and coloanal anastomosis were randomized to at least two different anastomotic techniques. Furthermore, a measure of postoperative bowel function was necessary for inclusion.

Data collection and analysis

Studies identified for potential inclusion were independently assessed for eligibility by at least two reviewers. Data from included trials was collected using a standardized data collection form. Data was collated and qualitatively summarized for bowel function outcomes and meta-analysis statistical techniques were used to pool data on postoperative complications.

Main results

Of 2609 relevant studies, 16 randomized controlled trials (RCTs) met our inclusion criteria. Nine RCTs (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 postop. Four RCTs (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, three RCTs (n=158) compared transverse coloplasty (TC) to CJP. Similarly, 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.

Authors' conclusions

In several randomized controlled trials, the CJP has been shown to be superior to the SCA in bowel function outcomes in patients with rectal cancer for at least 18 months after gastrointestinal continuity is re-established. The TC and STE anastomoses have been shown to have similar bowel function outcomes when compared to the CJP in small randomized controlled trials; further study is necessary to determine the role of these alternative coloanal anastomotic strategies.


Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要

Reconstructive Techniques After Rectal Resection for Rectal Cancer

Rectal cancer is a common cancer that requires surgical removal of the rectum and mesorectum for the best chance of cure. Advances in rectal cancer surgery have facilitated sphincter-preserving surgery in the majority of these patients. However, many of these people will have significant functional difficulties, including fecal incontinence, urgency and frequent bowel movements. Several surgical techniques (Colonic J pouch, transverse coloplasty and side-to-end anastomosis) have been created as alternatives to the standard straight coloanal anastomosis.
In this systematic review, we surmise that the colonic J pouch results in superior postoperative bowel function for at least 18 months after surgery, and possibly longer. Furthermore, the transverse coloplasty and side-to-end anastomosis appear to have similar advantages, but in a limited number of studies.



  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要







2名のレビューアが独自に、最初から2006年2月14日まで文献(MEDLINE、Cancerlit、EmbaseおよびCochrane Databases)をシステマティックに検索した。










監  訳: 柴田 実,2008.7.12

実施組織: 厚生労働省委託事業によりMindsが実施した。

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  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要



全直腸繫膜切除(Total mesorectal resection,TEM)已經大幅改善直腸癌患者的存活率並且降低局部癌症復發率,在接受TEM後直接施行直腸肛門延伸吻合術(Straight coloanal anastomosis)會引發排便頻繁、糞便尿急和大小便失禁的問題,colonic J pouch治療法、側邊對尾端的吻合接合法及低位結腸吻合法已經發展以作為替代性手術策略,希望能達到改善排便功能的效果




本研究係由2位研究人員對於文獻資料(MEDLINE、Cancerlit、Embase和 Cochrane資料庫)進行系統性的檢索,檢索的時間由2006年2月14日開始。






在2609個相關試驗中,有16個RCT試驗符合納入研究的範圍,有9個RCT試驗(包含473位受試者)直接比較大腸肛門吻合術(straight coloanal anastomosis,SCA)和colonic J pouch治療法(CJP)的治療效果經過術後至少18個月的觀察。在大多數研究中,使用CJP治療法在排便頻率、出現尿急、排便失禁和使用止瀉劑等治療成果上都優於SCA治療法的效果,至於這樣的優點是否可以持續到術後18個月只有極少數患有長期排便功能異常的患者可以提供相關數據,有4個RCT試驗(受試者215人)比較側邊對尾端吻合術(STE)和CJP的治療效果,這些試驗顯示使用這兩種技術對於排便功能相關成果並無顯著差異,類似的結果也出現在其他個比較橫向結腸整形術(transverse coloplasty ,(TC)和CJP治療效果的試驗中(受試者158人),在這些小型試驗中並無法顯示出這些方法在治療效果的差別,整體來說,使用任何吻合治療策略對於術後併發症的發生並沒有顯著差異




此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌