Colonic J-Pouch vs. straight colorectal reconstruction after anal preservation surgery for ultra-low rectal cancer: A prospective cohort study on quality of life and bowel function.

Background: Patients with ultra-low rectal cancer who underwent sphincter-preserving surgery are at high risk of poor anal function. Sphincter preservation in ultra-low rectal cancer poses significant challenges, and there is limited research exploring the impact of colonic J-pouch reconstruction on anal function in such patients. Given these challenges, the objective of this study was to assess the impact of colonic J-pouch reconstruction on quality of life and bowel function in patients who underwent sphincter-preserving surgery for ultra-low rectal cancer.

Methods: From February 2023 to July 2024, 66 patients with ultra-low rectal cancer who underwent sphincter-preserving surgery were prospectively included in the study. Patients were divided into two groups based on anastomotic techniques: direct anastomosis group and colon J-Pouch group. Subsequently, postoperative complication statistics, anal function, and quality of life assessment were conducted. The LARS, Wexner, and Vaizey scales were used to evaluate anal function, while the FIQL scale assessed patients' quality of life at 1, 3, and 6 months after surgery postoperatively. The Clavien-Dindo classification was used to assess postoperative complications. Differences in bowel function, quality of life, and complication rates between the 2 groups were analyzed.

Results: There was no difference in the incidence of postoperative Clavien-Dindo II and above complications between the 2 groups (25% vs. 26.5%, P = .183). In terms of bowel function, the colonic J-pouch anastomosis demonstrated superior LARS scores at 1 month (29 vs. 32, P = .006), 3 months (23 vs. 29, P < .001), and 6 months postoperatively (20 vs. 25, P < .001). Similarly, regarding quality of life, patients in the colonic J-pouch group reported higher FIQL scores than those in the direct anastomosis group at 1 month postoperatively (84 vs. 71, P = .001), 3 months postoperatively (94 vs. 81, P = .007), and 6 months postoperatively (104 vs. 91, P = .001).

Conclusions: Patients who underwent colonic J-pouch reconstruction for ultra-low rectal cancer had enhanced functional and quality-of-life outcomes compared to straight colorectal anastomosis. More research is needed to explore the long-term implications of this approach.