Trattamento chirurgico del cancro del retto con conservazione dello sfintere: risultati funzionali in rapporto alla sede dell'anastomosi.

Background. Unsatisfactory functional results are reported not only after coloanal anastomosis but also after anterior rectal resection with colorectal anastomosis. The aim of this study is to establish functional outcome predictive factors related to surgical technique and in particular the real influence of residual rectum length to identify which patients could take advantage of a colonic pouch reconstruction. Methods. In 214 of 327 patients who underwent surgery for rectal cancer sphincter preservation was achieved. These patients have been subdivided relating to the level of the anastomosis measured from the anal verge with a rigid proctoscope. In 93 patients functional results have been evaluated through clinical control and anorectal manometry. Results. In patients who underwent to anterior resection with anastomosis between 4 and 6 cm from the anal verge functional alterations appeared, such as leakage (13%), incontinence (5%), urgency (5%) and evacuation difficulty (10%). Nevertheless, comparing the anterior resections with anastomosis between 6 and 8 cm and those with anastomosis between 4 and 6 cm, the only parameter in which the difference resulted statistically significant was the rectal compliance. Conclusions. This result allows to consider that patients who undergo anterior resection with no more than 2-3 cm of residual rectum could take advantage by a colonic pouch reconstruction.