Rectal resection with low anastomosis: functional outcome
Article first published online: 15 AUG 2003
Volume 5, Issue 5, pages 458–464, September 2003
How to Cite
Matzel, K. E., Bittorf, B., Günther, K., Stadelmaier, U. and Hohenberger, W. (2003), Rectal resection with low anastomosis: functional outcome. Colorectal Disease, 5: 458–464. doi: 10.1046/j.1463-1318.2003.t01-1-00503.x
- Issue published online: 15 AUG 2003
- Article first published online: 15 AUG 2003
- Received 1 October 2002; accepted 1 December 2002
- Rectal resection;
- rectal cancer;
- postoperative function
Objective Function after anterior, low anterior and intersphincteric resection for rectal cancer was studied.
Method Of 139 patients 122 responded to a standardized questionnaire (Cleveland Clinic Continence Score) 108 ± 46 weeks postoperatively and 70 underwent anorectal manometry at 26 ± 15 weeks.
Results The postoperative continence score was dependent on the procedure (anterior resection 4.1 ± 4.6, low anterior resection 6.9 ± 5.6, intersphincteric resection 11.5 ± 5.2; P < 0.0001). It was poorer after radiochemotherapy (9.0 vs. 5.7; P = 0.030), but after colonic pouch reconstruction there was no significant difference between low anterior resection (5.6 vs. 7.3) and intersphincteric resection (10.0 vs. 12.5). Mean and maximal resting pressures were significantly reduced after intersphincteric resection (24 ± 9 and 40 ± 13 mmHg, respectively, P < 0.001) and further reduced by radiochemotherapy. Squeeze pressure was unaffected by the operative procedures and radiochemotherapy. Maximum tolerable volume and rectal compliance were reduced, after both low anterior and intersphincteric resection. Statistical correlation between continence score and maximal resting pressure (P = 0.014), mean resting pressure (P = 0.002), urge volume (P = 0.037), and neorectal compliance (P = 0.0018) reached significance. Satisfaction with the functional outcome was expressed by 71% of patients.
Conclusion After rectal resection the degree of impaired continence depended on the operative procedure and the form of reestablishment of intestinal continuity. Radiochemotherapy affected the outcome adversely. Despite reduced function, overall patient satisfaction was high.