대한대장항문학회

Purpose : Coloanal anastomosis (CAA) following ultralow anterior resection became more<br>popular techniques for preservation of anal sphincter in distal rectal cancer. The purpose of<br>this study is to evaluate a functional and oncologic safety of patients who underwent ultralow<br>anterior resection and coloanal anastomosis for distal rectal cancer. Methods : Forty-eight<br>patients underwent coloanal anastomosis following ultralow anterior resection between<br>January 1988 and January 1998. Main operative techniques were total mesorectal excision<br>with autonomic nerve preservation. Colonic J pouch was made 8 cm in length with GIA 95.<br>All patients were followed up for fecal or gas incontinence, frequency of bowel movement<br>and local or systemic recurrences. Results : Mean tumor distance from anal verge was 4.0<br>cm. Postoperative complications were transient urinary retention (N=7), anastomotic stenosis<br>(N=3), anastomotic leakage (N=3), rectovaginal fistula (N=2), cancer positive margin (N=1;<br>patient refuses reoperation). Overall recurrences occurred in 7/48 (14.5%). Local recurrence<br>(N=1) and systemic recurrence (N=1) in Astler-Coller stage B2, local recurrence (N=1),<br>systemic recurrence (N=2) and combined local and systemic recurrence (N=2) in<br>Astler-Coller stage C2. Mean frequency of bowel movement were 6.1 per day at 3 month, 4.4<br>at 1 year and 3.1 at 2 years. Kirwan grade for fecal incontinence were 2.7 at 3 months, 1.8<br>at 1 year and 1.5 at 2 years. Conclusions : With careful selection of patients and good<br>operative techniques, CAA can be performed safely in distal rectal cancer. Normal continence<br>and acceptable frequency of bowel movements can be obtained at 1 year after operation<br>without compromising the rate of local recurrence.<br>