Functional results after TME: J-pouch vs straight coloanal anastomosis and role of neoadjuvant radiochemotherapy.

AIM Purpose of this study was to evaluate short and long term functional outcomes after TME (total mesorectal excision) for rectal cancer. The role of straight anastomosis or colonic J-pouch reconstruction is investigated, as well as the impact of preoperative chemoradiotherapy is analyzed as a cause of the so called "anterior resection syndrome". METHODS We enrolled 40 patients (17 male and 23 female), in which a low anterior resection was performed: they were divided in four groups: A1 (Straight and no RCT), A2 (Straight and RCT), B1 (J-pouch and no RCT), B2 (J-pouch and RCT). Follow-up was performed six and twelve months after surgery, through a clinical questionnaire ( to assess: stool frequency, incomplete emptying, the presence of fecal leakage, urgency and incontinence ) and through anorectal manometry ( to assess rest pressure, squeeze pressure, max tolerated volume and compliance). Results were evaluated through T-Student and Chi-Squared test. RESULTS Six months after surgery, colonic J-pouch offers the best clinical and functional results, in both radiated and not radiated patients (except for incomplete emptying); in the straight group, however, there is an improvement of results after twelve months. Chemoradiation therapy is always associated with worse functional results. DISCUSSION RCT seems to invalidate J-pouch function in particular, in fact twelve months after surgery the difference between J-Pouch and Straight groups is not statistically different for most of the parameters. CONCLUSION J-pouch gives a real functional advantage for only six months after surgery, especially in patients treated with neoajuvant chemoradiation therapy.