Anovel neoanal canal and neosphincter reconstruction technique for the treatment of rectal malignancies using a pull-through sigmoidal smooth muscle cuff

2001 Fiscal Year Final Research Report Summary

• Project/Area Number: 12671211
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Single-year Grants
• Section: 一般
• Research Field: Digestive surgery
• Research Institution: TOYAMA MEDICAL AND PHARMACEUTICAL UNIVERSITY
• Principal Investigator: SAITO Mitsukazu Toyama Medical and Pharmaceutical university Hospital Assistant Professor, 医学部附属病院, 助手 (30270945)
• Co-Investigator(Kenkyū-buntansha): MINAMIMURA Tetsuji Toyama Medical and Pharmaceutical university Faculty of Medicine Assistant Professor, 医学部, 助手 (70324043)
• Project Period (FY): 2000 – 2001
• Keywords: rectal cancer / ultralow anterior resection / anal sphincter / smooth muscle / anal canal plasty

Research Abstract

PURPOSE: Ultralow anterior resection was performed with following reconstruction of neoanal canal and neosphincter using sigmoidal smooth muscle cuff, which substitutes the internal sphincter. This surgery aims at resection of the tumor with oncologically safe margins and improvement the quality of life (QOL) because of the voluntary anal control. METHODS: Three patients with rectal adenocarcinoma and 1 with GIST underwent this surgery. Wide local resection was done and reconstruction of neoanal canal and neosphincter was performed Follow-up was done. Assessment of function and QOL were recorded RESULTS: No tumoral recurrence was noted in the long-term follow-up of 4 years, in average, in all cases. The morbidity in the intermediate postoperative period was anal fistula in 2 patients and stricture of the anastomosis in one patient. Three cases had the covering ileostomy closed, and one case could not have it dosed due to persistent fistula. About one month after the surgical resection, sensation of defecation and continence to gas were achieved. After the closure of ileostomy in three cases, the daily bowel movements immediately after the resective surgery that were from 10 to 20 times a day, decreased to 3 to 7 times a day after 6 months. After 3 years, the bowel movements varied from 3 to 4 times a day. These three patients reported satisfaction with the bowel movements, voluntary control of evacuation, and maintenance of the QOL they had before surgery. CONCLUSION: These results show that reconstruction of neoanal canal and neosphincter using the preserved subcutaneous part of external sphincter muscle and anastomosis to sigmoidal smooth muscle cuff may be a good therapeutical approach in the management of selected cases of rectal carcinoma or malignancies of the anal canal mainly from the psychological point-of-view because the technique may promote the early social return and improve the QOL of these patients.