Assessment of Early Functional Outcome of Colonic J pouch Reservoir in Patients with Low Rectal Cancer

Abstract

Background: Sphincter-preserving low anterior resection (LAR) for low rectal cancer often results in low anterior resection syndrome (LARS), impacting quality of life. This study compared early functional outcomes of three neorectum reconstruction techniques: colonic J-pouch (CJP), side-to-end anastomosis (SEA), and transverse coloplasty (TCP).

Aim: To assess improve in quality of life and evaluate early functional outcomes of neorectal reservoirs in patients with low rectal cancer by restoring bowel function and continuity after rectal surgery.

Patients and methods: This prospective, observational, comparative study was conducted at Suez Canal University Hospital and military hospitals. The study included 60 patients diagnosed with low rectal cancer who underwent surgery involving neorectum reservoir reconstruction. Total Patients: 60, distributed across three groups: Group 1: Side-to-end (SEA, n=20), Group 2: Transverse Coloplasty (TCP, n=13), Group 3: Colonic J-Pouch (CJP, n=27).

Results: Groups were balanced in demographics (mean age 65.2 years; 53.3% male; BMI 24.5 kg/m²) and tumor stages (mostly T2N0M0). CJP demonstrated superior functional outcomes: lower LARS scores (15 [10-20] vs. 25 [20-30] SEA, p=0.01), reduced bowel frequency (2 [2-3] vs. 3 [2-4], p=0.02), fewer nighttime movements (p=0.04), better gas-stool discrimination (81.5%, p=0.05), and higher manometry pressures (p=0.01). Complications were comparable (e.g., ileus 13.3%), but CJP had zero reoperations/pelvic abscesses. Narrow pelvis predicted complications (OR 2.80, p=0.03).

Conclusion: CJP offers significant early functional benefits and safety trends over SEA and TCP, enhancing postoperative recovery and quality of life. Larger trials are needed for long-term validation.