• Colorectal anastomosis
• LARS
• Rectum resection
• Straight colorectal anastomosis
• low anterior resection

• Humans
• Anastomosis, Surgical/methods
• Quality of Life
• Rectal Neoplasms/surgery
• Anastomotic Leak/epidemiology
• Proctectomy/methods
• Rectum/surgery
• Colonic Pouches
• Plastic Surgery Procedures/methods

• Humans
• Prostatectomy/methods
• Prostatectomy/adverse effects
• Male
• Robotic Surgical Procedures
• Aged
• Middle Aged
• Pilot Projects
• Laparoscopy/methods
• Rectum/surgery
• Prostatic Neoplasms/surgery
• Anal Canal/physiopathology
• Postoperative Complications/etiology
• Fecal Incontinence/etiology
• Fecal Incontinence/physiopathology
• Defecation/physiology
• Time Factors

• Anterior rectal resection
• Cameroon
• bowel dysfunction
• low anterior rectal syndrome (LARS)
• rectal cancer

• Humans
• Male
• Cameroon
• Rectal Neoplasms/surgery
• Middle Aged
• Female
• Prospective Studies
• Cross-Sectional Studies
• Adult
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Syndrome
• Aged
• Time Factors
• Cohort Studies
• Proctectomy/adverse effects
• Proctectomy/methods
• Rectal Diseases/surgery
• Follow-Up Studies

• Humans
• Carcinoma
• Proctectomy
• Quality of Life
• Rectal Neoplasms/surgery
• Rectum/surgery

• anterior resection
• colonic J-pouch
• rectal cancer
• side-to-end anastomosis

• Humans
• Anal Canal/surgery
• Anastomosis, Surgical/methods
• Colon/surgery
• Colonic Pouches
• Proctectomy
• Proctocolectomy, Restorative
• Rectal Neoplasms/surgery
• Rectum/surgery
• Treatment Outcome

• Colon J-pouch
• Network meta-analysis
• Rectal cancer
• Side-to-end anastomosis
• Straight colorectal anastomosis
• Transverse coloplast

• Humans
• Constriction, Pathologic/surgery
• Rectum/surgery
• Rectal Neoplasms/surgery
• Colonic Pouches
• Anastomosis, Surgical/methods
• Anastomotic Leak/etiology
• Anastomotic Leak/surgery
• Colon/surgery
• Treatment Outcome
• Anal Canal/surgery
• Proctocolectomy, Restorative/methods

• Anastomosis
• Low anterior resection syndrome
• Mesorectal excision
• Proctectomy
• Rectal cancer

• Humans
• Male
• Female
• Middle Aged
• Aged
• Rectal Neoplasms/surgery
• Rectal Neoplasms/complications
• Follow-Up Studies
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Retrospective Studies
• Incidence
• Syndrome
• Rectum/surgery
• Rectal Diseases/complications

• Anastomosis techniques
• Rectal anastomosis
• Rectal cancer
• Stool frequency
• Total mesorectal excision

• Humans
• Fecal Incontinence/surgery
• Rectal Neoplasms/surgery
• Postoperative Complications
• Syndrome
• Colonic Pouches/adverse effects

• Diverting
• Leak
• Low Anterior Resection
• Meta-analysis
• Stoma

• Male
• Humans
• Female
• Retrospective Studies
• Randomized Controlled Trials as Topic
• Surgical Stomas/adverse effects
• Anastomotic Leak/etiology
• Anastomotic Leak/surgery
• Rectal Neoplasms/surgery
• Rectal Neoplasms/pathology
• Anastomosis, Surgical/adverse effects
• Risk Factors

• Anterior resection
• J-pouch
• Straight anastomosis

• practice guideline
• rectal cancer
• surgery
• treatment

The application of side-to-end anastomosis (SEA) in sphincter-preserving resection (SPR) is controversial. We performed a meta-analysis to compare the safety and efficacy of SEA with colonic J-pouch (CJP) anastomosis, which had been proven effective in improving postoperative bowel function.

The protocol was registered in PROSPERO under number CRD42020206764. PubMed, Embase, Web of Science, and the Cochrane Register of Controlled Trials databases were searched. The inclusion criteria were randomized controlled trials (RCTs) that evaluated the safety or efficacy of SEA in comparison with CJP anastomosis. The outcomes included the pooled risk ratio (RR) for dichotomous variables and weighted mean differences (WMDs) for continuous variables. All outcomes were calculated with 95% confidence intervals (CI) by STATA software (Stata 14, Stata Corporation, TX, USA).

A total of 864 patients from 10 RCTs were included in the meta-analysis. Patients undergoing SEA had a higher defecation frequency at 12 months after SPR (WMD = 0.20; 95% CI, 0.14–0.26; P < 0.01) than those undergoing CJP anastomosis with low heterogeneity (I² = 0%, P = 0.54) and a lower incidence of incomplete defecation at 3 months after surgery (RR = 0.28; 95% CI, 0.09–0.86; P = 0.03). A shorter operating time (WMD = − 17.65; 95% CI, − 23.28 to − 12.02; P < 0.01) was also observed in the SEA group without significant heterogeneity (I² = 0%, P = 0.54). A higher anorectal resting pressure (WMD = 6.25; 95% CI, 0.17–12.32; P = 0.04) was found in the SEA group but the heterogeneity was high (I² = 84.5%, P = 0.84). No significant differences were observed between the groups in terms of efficacy outcomes including defecation frequency, the incidence of urgency, incomplete defecation, the use of pads, enema, medications, anorectal squeeze pressure and maximum rectal volume, or safety outcomes including operating time, blood loss, the use of protective stoma, postoperative complications, clinical outcomes, and oncological outcomes.

The present evidence suggests that SEA is an effective anastomotic strategy to achieve similar postoperative bowel function without increasing the risk of complications compared with CJP anastomosis. The advantages of SEA include a shorter operating time, a lower incidence of incomplete defecation at 3 months after surgery, and better sphincter function. However, close attention should be paid to the long-term defecation frequency after SPR.

The online version contains supplementary material available at 10.1186/s12957-021-02243-0.

• Anastomosis
• J-pouch
• Low anterior resection syndrome
• Rectal cancer
• Side-to-end
• Sphincter-preserving resection

With advancements in laparoscopic technology and the wide application of linear staplers, sphincter-saving procedures are increasingly performed for low rectal cancer. However, sphincter-saving procedures have led to the emergence of a unique clinical disorder termed anterior rectal resection syndrome. Colonic pouch anastomosis improves the quality of life of patients with rectal cancer > 7 cm from the anal margin. But whether colonic pouch anastomosis can reduce the incidence of rectal resection syndrome in patients with low rectal cancer is unknown.

To compare postoperative and oncological outcomes and bowel function of straight and colonic pouch anal anastomoses after resection of low rectal cancer.

We conducted a retrospective study of 72 patients with low rectal cancer who underwent sphincter-saving procedures with either straight or colonic pouch anastomoses. Functional evaluations were completed preoperatively and at 1, 6, and 12 mo postoperatively. We also compared perioperative and oncological outcomes between two groups that had undergone low or ultralow anterior rectal resection.

There were no significant differences in mean operating time, blood loss, time to first passage of flatus and excrement, and duration of hospital stay between the colonic pouch and straight anastomosis groups. The incidence of anastomotic leakage following colonic pouch construction was lower (11.4% vs 16.2%) but not significantly different than that of straight anastomosis. Patients with colonic pouch construction had lower postoperative low anterior resection syndrome scores than the straight anastomosis group, suggesting better bowel function (preoperative: 4.71 vs 3.89, P = 0.43; 1 mo after surgery: 34.2 vs 34.7, P = 0.59; 6 mo after surgery: 22.70 vs 29.0, P < 0.05; 12 mo after surgery: 15.5 vs 19.5, P = 0.01). The overall recurrence and metastasis rates were similar (4.3% and 11.4%, respectively).

Colonic pouch anastomosis is a safe and effective procedure for colorectal reconstruction after low and ultralow rectal resections. Moreover, colonic pouch construction may provide better functional outcomes compared to straight anastomosis.

• Low rectal cancer
• Colonic pouch
• Rectal resection syndrome
• Low anterior rectal resection
• Bowel function
• Surgery

• Anastomosis, Surgical/adverse effects
• Anastomosis, Surgical/methods
• Colon/physiopathology
• Colonic Pouches/adverse effects
• Colorectal Surgery/methods
• Female
• Humans
• Male
• Middle Aged
• Patient Reported Outcome Measures
• Postoperative Complications/etiology
• Postoperative Complications/physiopathology
• Postoperative Complications/psychology
• Proctectomy/adverse effects
• Proctectomy/methods
• Plastic Surgery Procedures/adverse effects
• Plastic Surgery Procedures/methods
• Rectal Neoplasms/pathology
• Rectal Neoplasms/psychology
• Rectal Neoplasms/surgery

• Anastomoses
• Rectal cancer
• Sigmoid cancer

• Anastomotic leakage
• Colorectal cancer
• Diverting stoma

• Chemotherapy
• Colorectal surgery
• Neoadjuvant chemoradiotherapy
• Nonoperative management
• Total neoadjuvant therapy

• Chemotherapy, Adjuvant/methods
• Combined Modality Therapy/methods
• Disease-Free Survival
• Humans
• Neoadjuvant Therapy/methods
• Neoplasm Staging
• Prognosis
• Randomized Controlled Trials as Topic
• Rectal Neoplasms/drug therapy
• Rectal Neoplasms/pathology
• Rectal Neoplasms/surgery
• Rectal Neoplasms/therapy
• Rectum/pathology
• Standard of Care

• LARS—low anterior resection syndrome
• functional results
• intersphincteric resection (ISR)
• neoadjucant chemoradiation
• rectal cancer

• Wexner score
• functional outcome
• intersphincteric resection
• low rectal cancer
• survival

• Aged
• Aged, 80 and over
• Anal Canal/surgery
• Anastomosis, Surgical
• Colon/surgery
• Female
• Humans
• Male
• Middle Aged
• Neoplasm Staging
• Proctectomy/methods
• Proctectomy/mortality
• Prospective Studies
• Rectal Neoplasms/mortality
• Rectal Neoplasms/pathology
• Rectal Neoplasms/surgery
• Treatment Outcome

Anastomosis is a crucial step in radical cancer surgery. Despite being a daily practice in gastrointestinal surgery, anastomotic leakage (AL) stands as a frequent postoperative complication. Because of increased morbidity, mortality, combined with longer hospital stay, the rate of re-intervention, and poor oncological outcomes, AL is considered the most feared and life-threatening complication after colorectal resections. Furthermore, poor functional outcomes with a higher rate of a permeant stoma in 56% of patients this could negatively affect the patient’s quality of life. This a narrative review which will cover intraoperative anastomotic integrity assessment and preventive measures in order to reduce AL. Although the most important prerequisites for the creation of anastomosis is well-perfused and tension-free anastomosis, surgeons have proposed several preventive measures, which were assumed to reduce the incidence of AL, including antibiotic prophylaxis, intraoperative air leak test, omental pedicle flap, defunctioning stoma, pelvic drain insertion, stapled anastomosis, and general surgical technique. However, lack of clear evidence of which preventive measures is superior over the other combined with the fact that the decision remains based on the surgeon’s choice. Despite the advances in surgical techniques, AL remains a serious health problem associated with increased morbidity, mortality with additional cost. Many preventative measures were employed with no clear evidence supporting the superiority of stapled anastomosis over hand-Sewn anastomosis, coating of the anastomosis, or pelvic drain. Defunctioning stoma, when justified it could decrease the leakage-related complications and the incidence of reoperation. MBP combined with oral antibiotics still recommended.

• Anastomotic leakage
• Colorectal
• Resection
• Anastomosis
• Cancer
• Anastomotic disruption

• Aged
• Anastomosis, Surgical/adverse effects
• Anastomosis, Surgical/methods
• Anastomotic Leak/epidemiology
• Anastomotic Leak/etiology
• Colon/surgery
• Colonic Pouches/adverse effects
• Female
• Humans
• Incidence
• Male
• Middle Aged
• Plastic Surgery Procedures/adverse effects
• Plastic Surgery Procedures/methods
• Rectal Neoplasms/surgery
• Rectum/surgery
• Surgical Stapling/methods

• Anastomotic leakage
• Fecal diversion
• Fecal diverting device
• Ileostomy
• Low anterior resection
• Stoma

The aim of this review is to evaluate the outcomes after an intersphincteric resection (ISR) for patients with low-lying rectal cancer. Reports published in the literature regarding surgical, oncological, and functional outcomes of an ISR were reviewed. The morbidity after an ISR was 7.7%–32%, and anastomotic leakage was the most common adverse event. Local recurrence rates ranged from 0% to 12%, 5-year overall survival rates ranged from 62% to 92%, and rates of major incontinence ranged from 0% to 25.8% after an ISR. An ISR is a safe procedure for sphincter-saving rectal surgery in patients with very low rectal cancer; it does not compromise the oncological outcomes of the resection and is a valuable alternative to an abdominoperineal resection. While the functional outcomes after an ISR were found to be acceptable, the long-term functional outcome and quality of life still require careful investigation. ISRs have been performed with surgical and oncologic safety on patients with low-lying rectal cancer. However, patients must be selected very carefully for an ISR, considering the associated functional derangement and the limited extent of the resection.

• Functional outcome
• Intersphincteric resection
• Low-lying rectal cancer
• Oncologic outcome

Objectives: Intersphincteric resection (ISR) for low-lying rectal cancer (LRC) may induce major problems associated with anorectal function. In this study, we assessed the severity of ISR-induced impairment in anorectal function. Methods: In total, 45 patients followed up regularly ≥2 years after diverting ileostoma closure were eligible. The patients underwent ISR (n=35) or conventional coloanal anastomosis without resection of the internal anal sphincter (IAS) (n=10) for treatment of LRC from January 2000 to December 2011. We retrospectively compared anorectal function [stool frequency, urgency, Wexner incontinence scale (WIS) score, and patient satisfaction with bowel movement habits on a visual analog scale (VAS) score] for ≥2 years after stoma closure between the two groups. Results: The median follow-up period was 4.0 years (range, 2.0-6.5 years). Of the total, 17 (48.6%) patients who underwent ISR had poor anorectal function, including two with complete incontinence. Significant differences were found between the groups in the incidence of urgency (p=0.042), WIS score (p=0.024), and defecation disorder with a WIS score of ≥10 (p=0.034) but not in stool frequency. Based on the VAS score, 45.7% of patients who underwent ISR were dissatisfied with their bowel movement habits (p=0.041). Conclusions: Extensive resection of the IAS has negative short- and long-term effects on anorectal function.

• intersphincteric resection
• long-term outcomes of anorectal function
• low rectal cancer

Intersphincteric resection (ISR) has rapidly increased worldwide including laparoscopic surgery. However, there are some concerns for the definition of ISR, surgical technique, oncological outcome, anal function, and quality of life (QoL). The aim of the present study is to evaluate those issues. A review of this surgical technique was carried out by searching English language literature of the PubMed online database and appropriate articles were identified. With regard to open‐ISR, the morbidity rate ranged from 7.5% to 38.3%, with lower mortality rates. Local recurrence rates varied widely from 0% to 22.7%, with a mean follow‐up duration of 40–94 months. Disease‐free and overall 5‐year survival rates were 68–86% and 76–97%, respectively. Those outcomes were equivalent to laparoscopic‐ISR. Surgical and oncological outcomes of ISR were generally acceptable. However, accurate evaluation of anal function and QoL was difficult because of a lack of standard assessment of various patient‐related factors. The surgical and oncological outcomes after ISR seem to be acceptable. The ISR technique seems to be valid as an alternative to abdominoperineal resection in selected patients with a very low rectal cancer. However, both necessity for ISR and expectations of QoL impairment as a result of functional disorder should be fully discussed with patients before surgery.

• functional outcome
• intersphincteric resection
• local recurrence
• oncological outcome
• rectal cancer
• survival

• LAR syndrome
• low anterior resection
• rectal cancer

The CONSORT extension for patient reported outcomes (PROs) aims to improve reporting, but guidance on the optimal integration with clinical data is lacking. This study examines in detail the reporting of PROs and clinical data from randomized controlled trials (RCTs) in gastro-intestinal cancer to inform design and reporting of combined PRO and clinical data from trials to improve the ‘take home’ message for clinicians to use in practice.

The case study was undertaken in gastro-intestinal cancer trials. Well-conducted RCTs reporting PROs with validated instruments were identified and categorized into those combining PRO and clinical data in a single paper, or those separating data into linked primary and supplemental papers. Qualitative methods were developed to examine reporting of the critical interpretation of the trial results (trial exegesis) in the papers in relation of the PRO and clinical outcomes and applied to each publication category. Results were used to inform recommendations for practice.

From 1917 screened abstracts, 49 high quality RCTs were identified reported in 36 combined and 15 linked primary and supplemental papers. In-depth analysis of manuscript text identified three categories for understanding trial exegesis: where authors reported a “detailed”, “general”, or absent PRO rationale and integrated interpretation of clinical and PRO results. A total of 11 (30%) and 6 (16%) combined papers reported “detailed” PRO rationale and integrated interpretation of results although only 2 (14%) and 1 (7%) primary papers achieved the same standard respectively. Supplemental papers provide better information with 11 (73%) and 3 (20%) achieving “detailed” rationale and integrated interpretation of results. Supplemental papers, however, were published a median of 20 months after the primary RCT data in lower impact factor journals (median 16.8 versus 5.2).

It is recommended that single papers, with detailed PRO rationale and integrated PRO and clinical data are published to optimize trial exegesis. Further work to examine whether this improves the use of PRO data to inform practice is needed.

• Humans
• Patient Outcome Assessment
• Patient Reported Outcome Measures
• Randomized Controlled Trials as Topic

• G0800800 Medical Research Council
• MR/K025643/1 Medical Research Council

Intersphincteric resection (ISR) has become an increasingly popular optional surgical tool for the treatment of very low rectal cancer. The purpose of this study was to assess the long-term oncological and functional outcomes of intersphincteric resection for T2 and T3 rectal cancer situated below 4 cm from the anal verge.

A total of 62 consecutive patients with very low rectal cancer who underwent ISR from 2001 to 2010 were classified into standard ISR for T2 lesions (Group I, n = 24) and extended ISR for T3 lesions (Group II, n = 38).

The 5-year overall survival rates were 95.8 % for group I and 94.7 % for group II. The 5-year recurrence-free survival rates were 87.5 % for group I and 86.8 % for group II. Bowel functions were evaluated at the 12^th and 24^th months after ileostomy closure in both groups. The frequency of bowel evacuation was higher in patients who underwent extended ISR than in those who underwent standard ISR at the 12^th month (p < 0.05). However, at the 24^th month, the frequencies decreased in both groups, exhibiting no significant difference. In the comparison based on the Kirwan classification, group I showed better continence status than group II but no significant difference. The Wexner scores of both groups revealed that the average score was 7.33 ± 2.8 in group I and 8.18 ± 2.9 in group II at the 12^th month, and at the 24^th month, the average score was 5.21 ± 1.7 in group I and 5.82 ± 1.9 in group II. There were no statistically significant differences between the two groups.

Extended ISR with quadrant resection of the upper external sphincter achieved good post-operative continence status, OS and RFS. Extended ISR can thus be an alternative to abdominoperineal resection for very low rectal cancer without compromising the chance of cure and improving quality of life.

• Colonic J
• Fecal incontinence
• Intersphincteric resection
• Oncologic outcome
• Pouch–neoadjuvant chemoradiotherapy
• Rectal cancer

• Laparoscopic surgery
• Nerve-sparing
• Quality of life
• Rectal cancer
• Sphincter preservation

• Anterior resection syndrome
• Biofeedback
• Fecal incontinence
• Rectal cancer

• Anastomotic failure
• Colorectal/coloanal anastomosis
• Covering stoma
• Rectal cancer