Reservoir Construction After Low Anterior Resection: Who and What?


Patient population

Intervention

Comparators

Outcomes studied

Rectal cancer patients undergoing low anterior resection with coloanal anastomosis

Colonic reservoir creation: J-pouch, transverse coloplasty, or side-to-end anastomosis

Straight coloanal anastomosis

Postoperative morbidity and functional outcomes





Search Strategy


A systematic literature search was conducted in the following bibliographic databases: MEDLINE (using PubMed) and the Cochrane Library since the inception of the databases until October 2015. In addition, reference lists of published systematic reviews were searched manually. Publications not written in English were excluded. Given the availability of multiple randomized controlled trials (RCTs), non-randomized trials were excluded. Only trials comparing two reconstructive procedures were included for review. Studies reporting on results with less than 6 months follow up were excluded with regards to functional outcomes. No restrictions were applied with regard to publication date. Titles and abstracts of retrieved studies were screened for relevance and eligibility. Results from the most recent meta-analyses were also included in this review. Full texts of all eligible studies were retrieved and reviewed.


Results


Our literature search retrieved 20 RCTs that prospectively compared outcomes with a straight CAA to one of the colonic reservoirs or compared outcomes between different types of colonic reservoirs (Table 47.2). We reviewed ten RCTs comparing a straight anastomosis (SA) to a colonic J pouch (JP), six studies comparing a JP to a transverse coloplasty (CP), four studies comparing a JP to a side-to-end anastomosis (STE), and one study comparing a SA to a CP. The vast majority of studies used a circular stapled technique for the coloanal anastomosis. The largest published RCT, by Fazio et al. [18],randomized patients in whom a JP was technically feasible to receive either a JP or a CP, and if a JP was not feasible to receive either a SA or a CP. For clarity sake, this study was treated as two separate studies in Table 47.2. Our review also included one well-designed, recently published meta-analysis [25] and the most recent Cochrane systematic review published in 2008 [26].


Table 47.2
Summary of randomized controlled trials included in this review


























































































































































































































































































































































Study
N
Anastomotic leak
Follow-up (months)
BM/24 h
Continence
Urgency
 
SA
JP
SA
JP
  
SA
JP
SA
JP
SA
JP

Straight coloanal (SA) vs. colonic J pouch (JP)

Seow Chen (1995) [4]
20
20
0
0
6
4
2*
        

12
2
2
−
+*
−
+

Ortiz (1995) [5]
19
19
2
2
12
11a

5a*
−
+
−
+

Hallbook (1996) [6]
52
45
8
1*
2
6.4
2*
−
+*
−
+*

12
3.5
2*
−
+*
−
+*

Lazorthes (1997) [7]
19
18
2
1
3
~5
~2*
−
+
−
+*

12
~4.5
~2*
−
+
−
+

24
~3.5
~2*
=
=
+
−

Ho (2000, 2001) [8, 9]
19
16
0
0
6
15b

6b*
−
+*
=
=

12
7.1
4.6*
−
+
+
−

24
7b

3b

−
+
=
=

Furst (2002) [10]
37
37
3
3
6
4.7
2.5*
−
+*
−
+

Oya (2002) [11]
21
20
0
0
6
4
3
−
+
=
=

12
3
2.5
−
+
=
=

Sailer (2002) [12]
32
32
4
3
3
1.2c

1.2c

−
+*
=
=

12
1.3 c

1.3 c

=
=
=
=

Park (2005) [13]
26
24
0
0
3
~11
~5*
−
+*
    

12
~6
~5
−
+*
    

Liang (2007) [14]
24
24
0
0
3
7
4*
−
+
+
−

6
6.5
4*
−
+
+
−

Colonic J pouch (JP) vs. transverse coloplasty (CP)

Ho (2002) [15]
44
44
0
7*
4
4.5
4.6
−
+*
−
+*

12
3
3.4
−
+
=
=

Pimentel (2003) [16]
15
15
1
2
3
4.1
3.9
+
−
−
+

6
3.4
3.1
+
−
−
+

12
2.8
2.1
+
−
=
=

Furst (2003) [17]
15
20
=
=
6
2.75
2
−
+
−
+

Fazio (2007) [18]
137
131
4
6
4
3
4*
+
−*
+
−

12
3
3*
+
−
+
−

24
2
3*
+
−*
+
−

Ulrich (2008) [19]

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Aug 23, 2017 | Posted by in ABDOMINAL MEDICINE | Comments Off on Reservoir Construction After Low Anterior Resection: Who and What?

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