Assessment of Anal Function after Low/Ultralow Rectal Anastomosis in Patients with Rectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Chang ^1,2 , LUO Yi ^1,2 , WANG Xiaodong ¹ , LI Li ¹

1.Surgery Center of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China;;
2.West China Medical School/MCQ Group of West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Anal function; Low/ultralow rectal cancer; Assessment method

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Objective To summarize the assessment methods of anal function after low/ultralow rectal anastomosis in patients with rectal cancer.
Methods Domestic and international publications on the study of evaluation of anal function after low/ultralow rectal anastomosis in patients with rectal cancer were collected and reviewed.
Results Anal function of patients with rectal cancer was usually evaluated by feeling of discharge, continence, perceptual function of rectum, defecate frequency, and defecation time, anal manometry and three-dimensional vector manometry were used as well. Recovery of anal function in patients with rectal cancer after low/ultralow rectal anastomosis depended on the integrity of anal canal, length of remaining rectum, level of anastomosis, and integrity of mucosa.
Conclusions Subjective assessment methods and auxiliary measuring instruments are the common means to evaluate the rectal-anal function. Subjective assessment method is simple and direct, but its accuracy is low; Auxiliary measuring instruments have high accuracy, while their examination costs are high and that of costs are not popular, the new assessment methods are needed for further research.

Citation： LIU Chang ,LUO Yi,WANG Xiaodong,LI Li. Assessment of Anal Function after Low/Ultralow Rectal Anastomosis in Patients with Rectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(9): 910-913. doi: Copy

1.	李立, 汪晓东, 舒晔, 等. 四川大学华西医院·结直肠癌手术治疗指南(四) [J]. 中国普外基础与临床杂志, 2009; 16(1): 7576.
2.	Pocard M, Sideris L, Zenasni F, et al. Functional results and quality of life for patients with very low rectal cancer undergoing coloanal anastomosis or perineal colostomy with colonic muscular graft [J]. Eur J Surg Oncol, 2007; 33(4): 459462.
3.	Ito M, Saito N, Sugito M, et al. Analysis of clinical factors associated with anal function after intersphincteric resection for very low rectal cancer [J]. Dis Colon Rectum, 2009; 52(1): 6470.
4.	Dehni N, Parc R, Church JM. Colonic Jpouchanal anastomosis for rectal cancer [J]. Dis Colon Rectum, 2003; 46(5): 667675.
5.	Rasmussen OO, Petersen IK, Christiansen J. Anorectal function following low anterior resection [J]. Colorectal Dis, 2003; 5(3): 258261.
6.	Yamada K, Ogata S, Saiki Y, et al. Functional results of intersphincteric resection for low rectal cancer [J]. Br J Surg, 2007; 94(10): 12721277.
7.	Kakodkar R, Gupta S, Nundy S. Low anterior resection with total mesorectal excision for rectal cancer: functional assessment and factors affecting outcome [J]. Colorectal Dis, 2006; 8(8): 650656.
8.	Chin CC, Yeh CY, Huang WS, et al. Clinical outcome of intersphincteric resection for ultralow rectal cancer [J]. World J Gastroenterol, 2006; 12(4): 640643.
9.	周波, 沈瑾, 张逖, 等. 老年直肠癌低位直肠前切除术后肛门功能初探 [J]. 同济大学学报(医学版), 2008; 29(5): 9495.
10.	徐忠法, 左文连, 荆奇. 现代肛肠肿瘤外科学 [M]. 济南: 山东科技出版社， 1993: 258261.
11.	吴凌云, 韩方海, 李衍杭, 等. 直肠癌低位吻合术后肛门功能评价 [J]. 大肠肛门病外科杂志, 1997; 3(3): 2629.
12.	韩方海, 吴凌云. 直肠癌低位吻合术后排便功能评价 [J]. 齐鲁肿瘤杂志, 1998; 5(3): 202203.
13.	刘军. 低位直肠癌保肛手术临床分析 [J]. 安徽医药, 2009; 13(7): 785787.
14.	Bittorf B, Stadelmaier U, Ghl J, et al. Functional outcome after intersphincteric resection of the rectum with coloanal anastomosis in low rectal cancer [J]. Eur J Surg Oncol, 2004; 30(3): 260265.
15.	Kishimoto Y, Araki Y, Sato Y, et al. Functional outcome after sphincter excision for ultralow rectal cancer [J]. Int Surg, 2007; 92(1): 4653.
16.	Efthimiadis C, Basdanis G, Zatagias A, et al. Manometric and clinical evaluation of patients after low anterior resection for rectal cancer [J]. Tech Coloproctol, 2004; 8 Suppl 1: s205s207.
17.	Dai Y, Jiang JB, Bi DS, et al. Preservation of the continence function after intersphincteric resection using a prolapsing technique in the patients with low rectal cancer and its clinical prognosis. [J]. Chin Med J (Engl), 2008; 121(20): 20162020.
18.	Bretagnol F, Rullier E, Laurent C, et al. Comparison of functional results and quality of life between intersphincteric resection and conventional coloanal anastomosis for low rectal cancer. [J]. Dis Colon Rectum, 2004; 47(6): 832838.
19.	Rao SS. American College of Gastroenterology Practice Parameters Committee. Diagnosis and management of fecal incontinence [J]. Am J Gastroenterol, 2004; 99(8): 15851604.
20.	傅传刚, 丁建华. 直肠癌手术直接吻合与贮袋结直肠／肛管吻合术后生活质量的比较 [J]. 中国普外基础与临床杂志, 2005; 12(1): 79.
21.	Murata A, Brown CJ, Raval M, et al. Impact of shortcourse radiotherapy and low anterior resection on quality of life and bowel function in primary rectal cancer [J]. Am J Surg, 2008; 195(5): 611615.
22.	Jorge JM, Wexner SD. Etiology and management of fecal incontinence [J]. Dis Colon Rectum, 1993; 36(1): 7797.
23.	Stadelmaier U, Bittorf B, Meyer M, et al. Can continence function after rectal resection be prognostically estimated? [J]. Chirurg, 2000; 71(8): 932938.
24.	马骏, 冯勇, 丛进春, 等. 低位直肠癌保肛术后的吻合口水平对排便功能及生活质量的影响 [J]. 世界华人消化杂志, 2009; 17(2): 221224.
25.	Tomita R. Sacral nerve function in patients with soiling more than 10 years after low anterior resection for lower rectal cancer [J]. Hepatogastroenterology, 2009; 56(89): 120123.
26.	van Duijvendijk P, Slors F, Taat CW, et al. A prospective evaluation of anorectal function after total mesorectal excision in patients with a rectal carcinoma [J]. Surgery, 2003; 133(1): 5665.
27.	Simpson RR, Kennedy ML, Nguyen MH, et al. Anal manometry: a comparison of techniques [J]. Dis Colon Rectum, 2006; 49(7): 10331038.
28.	Günal O, Gürleyik E, Arikan Y, et al. Assessment of anal sphincter function by SengstakenBlakemore tube anal manometry [J]. World J Surg, 2007; 31(2): 399402.
29.	Koda K, Yasuda H, Hirano A, et al. Evaluation of postoperative damage to anal sphincter/levator ani muscles with threedimensional vector manometry after sphincterpreserving operation for rectal cancer [J]. J Am Coll Surg, 2009; 208(3): 362367.
30.	Saito N, Ono M, Sugito M, et al. Early results of intersphincteric resection for patients with very low rectal cancer: an active approach to avoid a permanent colostomy [J]. Dis Colon Rectum, 2004; 47(4): 459466.
31.	Lee SJ, Park YS. Serial evaluation of anorectal function following low anterior resection of the rectum [J]. Int J Colorectal Dis, 1998; 13(56): 241246.
32.	Wietek BM, Hinninghofen H, Jehle EC, et al. Asymmetric sphincter innervation is associated with fecal incontinence after anal sphincter trauma during childbirth [J]. Neurourol Urodyn, 2007; 26(1): 134139.
33.	Matsushita K, Yamada K, Sameshima T, et al. Prediction of incontinence following low anterior resection for rectal carcinoma [J]. Dis Colon Rectum, 1997; 40(5): 575579.
34.	Batignani G, Monaci I, Ficari F, et al. What affects continence after anterior resection of the rectum? [J]. Dis Colon Rectum, 1991; 34(4): 329335.
35.	Ho YH, Wong J, Goh HS. Level of anastomosis and anorectal manometry in predicting function following anterior resection for adenocarcinoma [J]. Int J Colorectal Dis, 1993; 8(3): 170174.
36.	Ho P, Law WL, Chan SC, et al. Functional outcome following low anterior resection with total mesorectal excision in the elderly [J]. Int J Colorectal Dis, 2003; 18(3): 230233.
37.	Hida J, Yoshifuji T, Tokoro T, et al. Longterm functional outcome of low anterior resection with colonic Jpouch reconstruction for rectal cancer in the elderly [J]. Dis Colon Rectum, 2004; 47(9): 14481454.
38.	Matzel KE, Bittorf B, Günther K, et al. Rectal resection with low anastomosis: functional outcome [J]. Colorectal Dis, 2003; 5(5): 458464.
39.	Tonelli F, Garcea A, Batignani G. Different role of the colonic pouch for low anterior resection and coloanal anastomosis [J]. Tech Coloproctol, 2005; 9(1): 1520.
40.	丛进春, 戴显伟, 张宏, 等. 低位直肠癌经内外括约肌间切除术后直肠肛管向量测压的研究 [J]. 中国普外基础与临床杂志, 2007; 14(6): 634638.
41.	Pedersen IK, Christiansen J, Hint K, et al. Anorectal function after low anterior resection for carcinoma [J]. Ann Surg, 1986; 204(2): 133135.
42.	丛进春, 戴显伟, 张宏, 等. 超低位直肠癌经括约肌间切除术后的肛门功能评价 [J]. 中国现代医学杂志, 2008; 18(6): 795798.

1. 李立, 汪晓东, 舒晔, 等. 四川大学华西医院·结直肠癌手术治疗指南(四) [J]. 中国普外基础与临床杂志, 2009; 16(1): 7576.
2. Pocard M, Sideris L, Zenasni F, et al. Functional results and quality of life for patients with very low rectal cancer undergoing coloanal anastomosis or perineal colostomy with colonic muscular graft [J]. Eur J Surg Oncol, 2007; 33(4): 459462.
3. Ito M, Saito N, Sugito M, et al. Analysis of clinical factors associated with anal function after intersphincteric resection for very low rectal cancer [J]. Dis Colon Rectum, 2009; 52(1): 6470.
4. Dehni N, Parc R, Church JM. Colonic Jpouchanal anastomosis for rectal cancer [J]. Dis Colon Rectum, 2003; 46(5): 667675.
5. Rasmussen OO, Petersen IK, Christiansen J. Anorectal function following low anterior resection [J]. Colorectal Dis, 2003; 5(3): 258261.
6. Yamada K, Ogata S, Saiki Y, et al. Functional results of intersphincteric resection for low rectal cancer [J]. Br J Surg, 2007; 94(10): 12721277.
7. Kakodkar R, Gupta S, Nundy S. Low anterior resection with total mesorectal excision for rectal cancer: functional assessment and factors affecting outcome [J]. Colorectal Dis, 2006; 8(8): 650656.
8. Chin CC, Yeh CY, Huang WS, et al. Clinical outcome of intersphincteric resection for ultralow rectal cancer [J]. World J Gastroenterol, 2006; 12(4): 640643.
9. 周波, 沈瑾, 张逖, 等. 老年直肠癌低位直肠前切除术后肛门功能初探 [J]. 同济大学学报(医学版), 2008; 29(5): 9495.
10. 徐忠法, 左文连, 荆奇. 现代肛肠肿瘤外科学 [M]. 济南: 山东科技出版社， 1993: 258261.
11. 吴凌云, 韩方海, 李衍杭, 等. 直肠癌低位吻合术后肛门功能评价 [J]. 大肠肛门病外科杂志, 1997; 3(3): 2629.
12. 韩方海, 吴凌云. 直肠癌低位吻合术后排便功能评价 [J]. 齐鲁肿瘤杂志, 1998; 5(3): 202203.
13. 刘军. 低位直肠癌保肛手术临床分析 [J]. 安徽医药, 2009; 13(7): 785787.
14. Bittorf B, Stadelmaier U, Ghl J, et al. Functional outcome after intersphincteric resection of the rectum with coloanal anastomosis in low rectal cancer [J]. Eur J Surg Oncol, 2004; 30(3): 260265.
15. Kishimoto Y, Araki Y, Sato Y, et al. Functional outcome after sphincter excision for ultralow rectal cancer [J]. Int Surg, 2007; 92(1): 4653.
16. Efthimiadis C, Basdanis G, Zatagias A, et al. Manometric and clinical evaluation of patients after low anterior resection for rectal cancer [J]. Tech Coloproctol, 2004; 8 Suppl 1: s205s207.
17. Dai Y, Jiang JB, Bi DS, et al. Preservation of the continence function after intersphincteric resection using a prolapsing technique in the patients with low rectal cancer and its clinical prognosis. [J]. Chin Med J (Engl), 2008; 121(20): 20162020.
18. Bretagnol F, Rullier E, Laurent C, et al. Comparison of functional results and quality of life between intersphincteric resection and conventional coloanal anastomosis for low rectal cancer. [J]. Dis Colon Rectum, 2004; 47(6): 832838.
19. Rao SS. American College of Gastroenterology Practice Parameters Committee. Diagnosis and management of fecal incontinence [J]. Am J Gastroenterol, 2004; 99(8): 15851604.
20. 傅传刚, 丁建华. 直肠癌手术直接吻合与贮袋结直肠／肛管吻合术后生活质量的比较 [J]. 中国普外基础与临床杂志, 2005; 12(1): 79.
21. Murata A, Brown CJ, Raval M, et al. Impact of shortcourse radiotherapy and low anterior resection on quality of life and bowel function in primary rectal cancer [J]. Am J Surg, 2008; 195(5): 611615.
22. Jorge JM, Wexner SD. Etiology and management of fecal incontinence [J]. Dis Colon Rectum, 1993; 36(1): 7797.
23. Stadelmaier U, Bittorf B, Meyer M, et al. Can continence function after rectal resection be prognostically estimated? [J]. Chirurg, 2000; 71(8): 932938.
24. 马骏, 冯勇, 丛进春, 等. 低位直肠癌保肛术后的吻合口水平对排便功能及生活质量的影响 [J]. 世界华人消化杂志, 2009; 17(2): 221224.
25. Tomita R. Sacral nerve function in patients with soiling more than 10 years after low anterior resection for lower rectal cancer [J]. Hepatogastroenterology, 2009; 56(89): 120123.
26. van Duijvendijk P, Slors F, Taat CW, et al. A prospective evaluation of anorectal function after total mesorectal excision in patients with a rectal carcinoma [J]. Surgery, 2003; 133(1): 5665.
27. Simpson RR, Kennedy ML, Nguyen MH, et al. Anal manometry: a comparison of techniques [J]. Dis Colon Rectum, 2006; 49(7): 10331038.
28. Günal O, Gürleyik E, Arikan Y, et al. Assessment of anal sphincter function by SengstakenBlakemore tube anal manometry [J]. World J Surg, 2007; 31(2): 399402.
29. Koda K, Yasuda H, Hirano A, et al. Evaluation of postoperative damage to anal sphincter/levator ani muscles with threedimensional vector manometry after sphincterpreserving operation for rectal cancer [J]. J Am Coll Surg, 2009; 208(3): 362367.
30. Saito N, Ono M, Sugito M, et al. Early results of intersphincteric resection for patients with very low rectal cancer: an active approach to avoid a permanent colostomy [J]. Dis Colon Rectum, 2004; 47(4): 459466.
31. Lee SJ, Park YS. Serial evaluation of anorectal function following low anterior resection of the rectum [J]. Int J Colorectal Dis, 1998; 13(56): 241246.
32. Wietek BM, Hinninghofen H, Jehle EC, et al. Asymmetric sphincter innervation is associated with fecal incontinence after anal sphincter trauma during childbirth [J]. Neurourol Urodyn, 2007; 26(1): 134139.
33. Matsushita K, Yamada K, Sameshima T, et al. Prediction of incontinence following low anterior resection for rectal carcinoma [J]. Dis Colon Rectum, 1997; 40(5): 575579.
34. Batignani G, Monaci I, Ficari F, et al. What affects continence after anterior resection of the rectum? [J]. Dis Colon Rectum, 1991; 34(4): 329335.
35. Ho YH, Wong J, Goh HS. Level of anastomosis and anorectal manometry in predicting function following anterior resection for adenocarcinoma [J]. Int J Colorectal Dis, 1993; 8(3): 170174.
36. Ho P, Law WL, Chan SC, et al. Functional outcome following low anterior resection with total mesorectal excision in the elderly [J]. Int J Colorectal Dis, 2003; 18(3): 230233.
37. Hida J, Yoshifuji T, Tokoro T, et al. Longterm functional outcome of low anterior resection with colonic Jpouch reconstruction for rectal cancer in the elderly [J]. Dis Colon Rectum, 2004; 47(9): 14481454.
38. Matzel KE, Bittorf B, Günther K, et al. Rectal resection with low anastomosis: functional outcome [J]. Colorectal Dis, 2003; 5(5): 458464.
39. Tonelli F, Garcea A, Batignani G. Different role of the colonic pouch for low anterior resection and coloanal anastomosis [J]. Tech Coloproctol, 2005; 9(1): 1520.
40. 丛进春, 戴显伟, 张宏, 等. 低位直肠癌经内外括约肌间切除术后直肠肛管向量测压的研究 [J]. 中国普外基础与临床杂志, 2007; 14(6): 634638.
41. Pedersen IK, Christiansen J, Hint K, et al. Anorectal function after low anterior resection for carcinoma [J]. Ann Surg, 1986; 204(2): 133135.
42. 丛进春, 戴显伟, 张宏, 等. 超低位直肠癌经括约肌间切除术后的肛门功能评价 [J]. 中国现代医学杂志, 2008; 18(6): 795798.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Assessment of Anal Function after Low/Ultralow Rectal Anastomosis in Patients with Rectal Cancer

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