J.Jpn. Surg. Soc.. 88(9): 1312-1315, 1987

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Report on the annual meeting

RESTORATIVE OPERATION FOR RECTAL CANCER AIMED AT ANAL SPHINCTER PRESERVATION

From 1970 to 1985, 449 patients with rectal cancer underwent restorative operations. Low anterior resection (LAR) was performed in 235 patients and their 5 year survival rate was 78％. Thus, recently, sphincter saving resection has become more widely adopted to the patients with rectal cancer and has led to renewed interest of postoperative bowel function. In 75 patients investigated with clinical symptoms, 76 percent of these patients had complaint of frequent defecation and 24 percent had a impaired anal sensation. Furthermore, the patients with low rectal cancer showed high incidence of fecal soiling. On the other hand, serial manometric evaluation of anorectal function studied in 21 patients on average 1.9 year after LAR showed significant lower rectal compliance and lower maximum volume of tolerance, whereas resting anal canal pressure, maximum voluntary squeezing pressure and minimum volume of desire to defecate did not differ much from those of the control. However, according to these observations, it seemed likely that patients who had a occasional soiling exhibited manometric evidence of a weak anal sphincter and a lower compliance and patients who complained of frequent defecation (over 6 times a day) had a Iower rectal compliance. Furthermore, it was emphasized that one of the important factors influencing postoperative bowel dysfunction might be the abnormal motility of denervated proximal colon above the anastomosis.

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