REVIEW   

Minerva Surgery 2024 February;79(1):59-72

DOI: 10.23736/S2724-5691.23.10115-8

Copyright © 2023 EDIZIONI MINERVA MEDICA

language: English

Reconstructive techniques following low anterior resection for carcinoma of the rectum

Anuj GOYAL ¹, Anvin MATHEW ² ✉, Princy JOSEPH ³, Gourav KAUSHAL ⁴, Nirjhar R. RAKESH ¹, Puneet DHAR ⁵

¹ Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, India; ² Department of Surgical Gastroenterology, Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, India; ³ National Health Systems and Research Center, New Delhi, India; ⁴ Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bathinda, India; ⁵ Department of Surgical Gastroenterology, Amrita Hospitals, Faridabad, India

INTRODUCTION: Multiple reconstructive techniques have been described for reconstruction after a low anterior resection for carcinoma rectum. Colonic J pouch (CJP), Side to end anastomosis (SEA), transverse coloplasty pouch (TCP) and Straight Colo-rectal/anal anastomosis were the most widely studied.
EVIDENCE ACQUISITION: PubMed, Embase and Cochrane data base were searched for randomized, non-randomized studies and systematic reviews from inception of the databases till July 31^st, 2023.
EVIDENCE SYNTHESIS: Considerable heterogeneity existed among different study findings. Reservoir techniques, including CJP, SEA, and TCP, exhibited reduced stool frequency, decreased urgency, and improved continence status compared to SCA, particularly in the short term. CJP maintained this advantage into the intermediate term. Other functional outcomes were similar among the techniques. However, these functional improvements did not translate into enhanced Quality of Life (QoL). TCP was associated with an elevated risk of anastomotic leaks. Other surgical outcomes remained comparable across all four techniques. Sexual outcomes also exhibited no significant variation. Some studies suggested that the size of the side limb in CJP or SEA may not significantly impact functional outcomes, implying that neorectum capacity may not be the primary determinant of improved function. The precise physiological mechanism underlying these findings remains unknown.
CONCLUSIONS: In the short and intermediate terms, reservoir techniques demonstrated superior functional outcomes, but long-term performance was comparable among all techniques. Notably, enhanced functional outcomes did not translate to improved Quality of Life. TCP, while effective, is linked to an increased risk of anastomotic complications, necessitating cautious utilization.

KEY WORDS: Low anterior resection syndrome; Colorectal neoplasms; Rectal neoplasms; Colorectal surgery