Function Preserving Operation -Sphincter- Saving Operation for Lower Rectal Cancer

Takayuki Morita

Department of Surgery, Hirosaki University Hospital

Many attention has been focused on sphincter-saving operation for the patients with lower rectal cancer, and has led to renewed interest of indication and functional outcome of postoperative bowel movement. Most of the patients with curative resection were found to have no distal intramural spread, which did not appear to have great significance for operative indication. The results of analysis of another clinicopathological factors suggested that sphincter-preserving operation did not carry an increase risk of recurrence compared with abdominoperineal resection, unless the cancer had low grade differentiation and extension beyond the proper muscle infiltrating deeper. Radical lymph node dissection have been applied in both patients having sphincter-saving operation and abdominoperineal resection. Organ and/or nerve preserving operation can be consistent with radical lymph node dissection for lower rectal cancer. Postoperative care following sphincter-saving operation is essential. Our experiences indicate that inadequate blood supply and damage of bowel itself on suture line are important risk factors of anastomotic leak. On the other hand, some patients having sphincter-saving operation have often experienced bowel dysfunction. To improve these problems, reconstruction with colonic J-pouch have been performed. The patients who received colonic J-pouch anastomosis had fewer defection symptoms. Colorectal surgeons should be challenge to balance both curability and functional preservation for better postoperative quality of life.

Key words
sphincter preserving operation for lower rectal cancer, colonic J-pouch anastomosis, postoperative bowel function

Reprint requests
Takayuki Morita Department of Surgery, Hirosaki University Hospital 5 Zeifu-cho, Hirosaki, 036-8216 JAPAN

Accepted
October 26, 1999

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