Function of the distal rectum after low anterior resection for carcinoma
From a personal series of 232 anterior resections performed over 10 years, functional results have been analysed in two specific groups of patients: those with anastomoses 3 cm (n = 26) and 6 cm ( n = 42) from the anal verge. In both groups low anterior resection had been performed with total mesorectal excision. Function was assessed in four categories: bowel frequency, ability to distinguish flatus from faeces, ability to defer defaecation, and frequency of soiling. Independent analysis of the 3 cm group showed a signijicant deterioration in function in each category after operation. The ability to defer defaecation and the frequency of soiling were unchanged after operation in the 6 c m group, and these functions were significantly better than in the 3 cm group. On the basis of these results, patients undergoing low anterior resection with total mesorectal excision should beneJit from the preservation of a short segment of distal rectum, provided that the distal resection margin is not compromised.
Anterior resection for low rectal cancer is appropriate provided total mesorectal excision (TME) is performed' and an adequate distal bowel clearancezs3 is achieved. Although there should be no compromise on the distal resection margin, there have been suggestion^^.^ that the standard requirement for 5 cm distal clearance can be reduced to 2 cm without any increase in local recurrence rates. Recently it has been shown4 that there is no significant difference in local recurrence rates in patients undergoing anterior resection with TME when the resection margin is < 1 cm, compared with a resection margin > 1 cm.
The technique of TME has been described el~ewhere'.~. It has been the practice in this unit to preserve as much distal rectum as possible in the belief that this would minimize any detrimental effect on continence and function. This study assessed whether preservation of the distal few centimetres of rectum affects functional results in uncomplicated low anterior resection.