Anal Function after Surgery for Low-Lying Rectal Cancer: Comparison of Mechanical and Hand-Sewn Coloanal Anastomosis

• Published in: Digestive surgery Vol. 34; no. 6; p. 469
• Main Authors: Matsunaga, Rie, Nishizawa, Yuji, Saito, Norio, Yokota, Mitsuru, Hayashi, Ryuichi, Ito, Masaaki
• Format: Journal Article
• Language: English
• Published: Switzerland 01-01-2017
• Subjects: Adult; Aged; Aged, 80 and over; Anal Canal - physiopathology; Anal Canal - surgery; Anastomosis, Surgical - methods; Colon - surgery; Defecation; Disease-Free Survival; Fecal Incontinence - etiology; Female; Follow-Up Studies; Humans; Male; Middle Aged; Organ Sparing Treatments - methods; Rectal Neoplasms - surgery; Retrospective Studies; Surveys and Questionnaires; Survival Rate; Suture Techniques; Wexner incontinence score; Anal function; Low-lying rectal cancer; Mechanical coloanal anastomosis; Hand-sewn coloanal anastomosis
• ISSN: 1421-9883
• DOI: 10.1159/000456080

Mechanical coloanal anastomosis (MCAA) or hand-sewn coloanal anastomosis (HCAA) are used in anus-preserving surgery for low-lying rectal cancer. Either method can be used if the lower edge of the tumor is 4-6 cm from the anal verge. The goal of this study was to evaluate differences in the anal function after MCAA or HCAA.
The subjects were 305 consecutive patients with primary rectal cancer tumors situated 4-6 cm from the anal verge who underwent curative anus-preserving surgery between 2004 and 2013. Functional assessment was performed using a questionnaire at 3, 6, 12, and 24 months after stoma closure.
Of the 305 patients, 145 underwent MCAA and 160 underwent HCAA. The median distance of the tumor from the anal verge was 6.0 cm (range 4.0-6.0) in the MCAA group and 4.5 cm (range 4.0-6.0) in the HCAA group (p < 0.001). A total of 192 patients (73%) responded to the 1-year questionnaire. The median Wexner score was 6 (range 0-17) in the MCAA group and 11 (range 0-20) in the HCAA group (p < 0.001).
Retention of anal function is feasible after both MCAA and HCAA. MCAA may contribute to better postoperative anal function compared to HCAA.