Индикации за дирекни или рекоструктивни анастомози според вида на сфинктерозапазващата операция при рак на ректума

Abstract

Purpose: The limited distal spread of the rectal cancer and the striving for better quality of life led to considerable increase of the sphincter preserving operations. However, development of anterior resection syndrome, particularly after adjuvant radiotherapy and low or ultralow resections, casts a shadow on this approach. Therefore, the efforts for development of surgical methods optimizing anal function are highly warranted. The objective of this paper was to determine the indications for direct or reconstructive anastomosis after sphincter preserving rectal surgery based on the functional effects and the rate of complications. Mat eria l an d meth ods: A total of 213 radical interventions for rectal cancer were performed. In the current study 164 cases were included who underwent a sphincter preserving operation for distal rectal cancer. In all of them, the anal function, kind of intervention and anastomosis performed, rate of complications and influence of radiotherapy were assessed. Results: The following interventions were performed: low and ultralow resection - 60, proctectomy - 81, and intrasphincteric resection - 23. Direct anastomosis was performed in 75 patients (46%) and reconstructive one in the remaining 89 (54%). Anastomotic leakage was noted in 26 patients (16%), as in 9 of them (5,5%) it was clinically significant and required relaparotomy. All of them presented with direct anastomosis without protective ileostomy. Anterior resection syndrome was more pronounced after direct coloanal anastomoses in patients aged over 65 years, after radiotherapy and in the patients with anastomotic breakdown as well. Conc lusion: Restorative proctectomy and intrasphincteric resection, adjuvant radiotherapy and age over 65 years are indications for reconstructive anastomosis with protective ileostomy. This is associated with diminished frequency and severity of anterior resection syndrome and improvement of patient`s quality of life.