BACKGROUND: With low anterior resection (LAR) for rectal cancer, the oncologic outcomes are recently good. A diverting ileostomy is often created to protect the newly constructed anastomosis; seldom is a permanent stoma needed. Predicting postoperative anorectal function remains difficult, however. We speculated that the endoscopic appearance of the anastomosis before ileostomy closure is predictive of the post-operative anorectal function and tested our hypothesis retrospectively. METHODS: Included in the study were 80 patients who, between September 2014 and August 2017, underwent LAR at Kanagawa Cancer Center. A diverting stoma had been created during the primary surgery, and ileostomy closure was performed about 6 months later. The anastomosis was examined endoscopically just before ileostomy closure, and the features were scored by two well-trained endoscopists. Daily defecation frequency and incontinence (Kirwan Score) were assessed after closure through physician-patient interview, and correlation between endoscopic feature scores and these measures of anorectal function was tested. RESULTS: Documented endoscopic features included erythema in 79% of patients, erosion (45%), ulceration (5%), granulomatous change (41.3%), granular protrusions (17.5%); hemorrhagic (20.0%) or white-coated (30.0%) mucosa. Anastomosis stricture <9 mm was 17.5%. Median daily defecation frequency after ileostomy closure was 4 (range, 0-20). Moderate positive correlation was found between endoscopic scores and postoperative anorectal function (r=0.60, P<0.001). CONCLUSIONS: In recording and analyzing endoscopic features of the anastomosis before ileostomy closure in a large number of patients treated by LAR, we found that the features might indeed be clinically useful in predicting post-LAR anorectal function.
BACKGROUND: With low anterior resection (LAR) for rectal cancer, the oncologic outcomes are recently good. A diverting ileostomy is often created to protect the newly constructed anastomosis; seldom is a permanent stoma needed. Predicting postoperative anorectal function remains difficult, however. We speculated that the endoscopic appearance of the anastomosis before ileostomy closure is predictive of the post-operative anorectal function and tested our hypothesis retrospectively. METHODS: Included in the study were 80 patients who, between September 2014 and August 2017, underwent LAR at Kanagawa Cancer Center. A diverting stoma had been created during the primary surgery, and ileostomy closure was performed about 6 months later. The anastomosis was examined endoscopically just before ileostomy closure, and the features were scored by two well-trained endoscopists. Daily defecation frequency and incontinence (Kirwan Score) were assessed after closure through physician-patient interview, and correlation between endoscopic feature scores and these measures of anorectal function was tested. RESULTS: Documented endoscopic features included erythema in 79% of patients, erosion (45%), ulceration (5%), granulomatous change (41.3%), granular protrusions (17.5%); hemorrhagic (20.0%) or white-coated (30.0%) mucosa. Anastomosis stricture <9 mm was 17.5%. Median daily defecation frequency after ileostomy closure was 4 (range, 0-20). Moderate positive correlation was found between endoscopic scores and postoperative anorectal function (r=0.60, P<0.001). CONCLUSIONS: In recording and analyzing endoscopic features of the anastomosis before ileostomy closure in a large number of patients treated by LAR, we found that the features might indeed be clinically useful in predicting post-LAR anorectal function.
Entities:
Keywords:
Endoscopy; anastomosis; ileostomy; rectal cancer
Authors: Catherine L C Bryant; Peter J Lunniss; Charles H Knowles; Mohamed A Thaha; Christopher L H Chan Journal: Lancet Oncol Date: 2012-09 Impact factor: 41.316
Authors: Bruno Rosa; Rolando Pinho; Susana Mão de Ferro; Nuno Almeida; José Cotter; Miguel Mascarenhas Saraiva Journal: GE Port J Gastroenterol Date: 2015-10-01