Purpose: To determine the efficacy of proctectomy with coloanal anastomosis for adenocarcinoma of the lower third of the rectum, and to compare quality of life after colonal anatomosis with low anterior rectal resection.
Material and methods: Twenty coloanal anatomosies were performed on 1996-2001 in Kaunas Medical University Hospital. Coloanal anatomosis was performed due to 1 villous adenoma and 19 adenocarcinomas. Postoperative functional results and quality of life were assessed by questionnaire, which was sent by mail to 17 patients after coloanal anatomosis and randomly assigned to 35 patients after low anterior rectal resection. Questionnaire was answered by 10 patients (59%) after coloanal anatomosis and 23 patients (66%) after low anterior rectal resection.
Results: Four general and 7 surgical complications occurred after coloanal anatomosis. Postoperative mortality was 15% (3 cases). Symptomatic anastomotic strictures revealed in 2 patients. The frequency of defecation 6 and more times per day after coloanal anatomosis were in 2 cases (20%) and after low anterior rectal resection in 3 cases (13%). In coloanal anatomosis group normal continence occurred in 40% of cases and after low anterior rectal resection--in 65%. One patient had incontinence of solids after low anterior rectal resection. In 4 cases after low anterior rectal resection occurred stable urine dysfunction. In coloanal anatomosis group sexual dysfunction occurred in 30% of cases, after low anterior rectal resection--in 22%. After both operations about 50% patients felt better. Hard social, emotional problems had only one patient with incontinence of solids. In other aspects quality of life was similar in both groups.
Conclusions: Proctectomy with coloanal anastomosis is suitable and safe procedure to treat lower third rectal cancer, with functional results and quality of life similar to low anterior rectal resection.