|A Randomized Multicenter Trial To Compare Long-Term Functional Outcome and Complications of Surgical Procedures For Low Rectal Cancers|
|Massarat Zutshi*1, Victor W Fazio*1, Feza Remzi1, R Ruppert2, Y Parc3, J Celebreeze, Jr.4, A Fuerst5, G Orangio6, N Hyman7, S Galanduik8 |
1Cleveland Clinic Foundation, Cleveland, OH;2Krankenhaus Munchen Neuperlach, Munich, Germany3Hospital Saint Antoine, Paris, France4Allegheny General Hospital, Pittsburgh, PA;5Caritas St Joseph Clinic, Regensberg, Germany6Georgia Colon and Rectal, Atlanta, GA;7Fletcher Allen Health Care, Burlington, VT;8University of Louisville, Louisville, KY
|Aim To compare prospectively complications and long-term functional outcome of patients undergoing coloplasty(CP),J Pouch(JP)or straight anastomosis(SA) for treatment of low rectal cancer.|
METHODS: A multicentered study enrolled patients with low rectal cancer, and randomized to coloplasty CP-1 or SA if J- pouch was not feasible, or JP or coloplasty CP-2 if a J-pouch was feasible. Patients were followed for 24 months withFecal Incontinence Severity Index(FISI)and SF-36 surveys for quality of life(QOL)
RESULTS: 364 patients randomized. and evaluated for complications and recurrence.
Mean age was 60 years, 71% male.No difference was observed in the complications among the 4 groups. (Table)
297/364 were evaluated for functional outcome.No statistical difference seen in the bowel function between the CP-1 and SA groups.JP patients had fewer bowel movements, less clustering, used fewer pads and had a lower FISI than the CP-2 group .Other parameters were equivocal. QOL scores at 24 months were equal.
CONCLUSIONS: J pouch was superior to Coloplasty and SA with respect to short and long term function; ie. less frequency of stools; pad use; and fecal continence. CP1 functional outcome was similar to SA with some advantage in the short term with respect to fecal continence However, the QOL scores were equivocal.
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