Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2021; 13(3): 303-314
Published online Mar 27, 2021. doi: 10.4240/wjgs.v13.i3.303
Colonic pouch confers better bowel function and similar postoperative outcomes compared to straight anastomosis for low rectal cancer
Zhen-Zhou Chen, Yi-Dan Li, Wang Huang, Ning-Hui Chai, Zheng-Qiang Wei
Zhen-Zhou Chen, Wang Huang, Ning-Hui Chai, Zheng-Qiang Wei, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
Yi-Dan Li, Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
Author contributions: Chen ZZ and Li YD made substantial contributions to conception and design; Huang W and Chai NH contributed to the acquisition of data, analysis, and interpretation; Chen ZZ wrote the manuscript; Wei ZQ supervised the work and edited the manuscript.
Supported by Chongqing Key Diseases Research and Application Demonstration Program (Colorectal Cancer Prevention and Treatment Technology and Research Application Demonstration), No. 2019ZX003.
Institutional review board statement: This study was approved by Ethics Committee of The First Affiliated Hospital of Chongqing Medical University (Approval No. 2019-250).
Informed consent statement: Considering that the research was retrospective, the need for patients’ informed written consent was waived.
Conflict-of-interest statement: Neither author has a potential conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Zheng-Qiang Wei, MD, Director, Doctor, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400000, China.
Received: December 2, 2020
Peer-review started: December 2, 2020
First decision: December 24, 2020
Revised: January 2, 2021
Accepted: January 14, 2021
Article in press: January 14, 2021
Published online: March 27, 2021

With advancements in laparoscopic technology and the wide application of linear staplers, sphincter-saving procedures are increasingly performed for low rectal cancer. However, sphincter-saving procedures have led to the emergence of a unique clinical disorder termed anterior rectal resection syndrome. Colonic pouch anastomosis improves the quality of life of patients with rectal cancer > 7 cm from the anal margin. But whether colonic pouch anastomosis can reduce the incidence of rectal resection syndrome in patients with low rectal cancer is unknown.


To compare postoperative and oncological outcomes and bowel function of straight and colonic pouch anal anastomoses after resection of low rectal cancer.


We conducted a retrospective study of 72 patients with low rectal cancer who underwent sphincter-saving procedures with either straight or colonic pouch anastomoses. Functional evaluations were completed preoperatively and at 1, 6, and 12 mo postoperatively. We also compared perioperative and oncological outcomes between two groups that had undergone low or ultralow anterior rectal resection.


There were no significant differences in mean operating time, blood loss, time to first passage of flatus and excrement, and duration of hospital stay between the colonic pouch and straight anastomosis groups. The incidence of anastomotic leakage following colonic pouch construction was lower (11.4% vs 16.2%) but not significantly different than that of straight anastomosis. Patients with colonic pouch construction had lower postoperative low anterior resection syndrome scores than the straight anastomosis group, suggesting better bowel function (preoperative: 4.71 vs 3.89, P = 0.43; 1 mo after surgery: 34.2 vs 34.7, P = 0.59; 6 mo after surgery: 22.70 vs 29.0, P < 0.05; 12 mo after surgery: 15.5 vs 19.5, P = 0.01). The overall recurrence and metastasis rates were similar (4.3% and 11.4%, respectively).


Colonic pouch anastomosis is a safe and effective procedure for colorectal reconstruction after low and ultralow rectal resections. Moreover, colonic pouch construction may provide better functional outcomes compared to straight anastomosis.

Keywords: Low rectal cancer, Colonic pouch, Rectal resection syndrome, Low anterior rectal resection, Bowel function, Surgery

Core Tip: With the increased use of sphincter-saving procedures, improvements of the quality of life of patients undergoing low or ultralow anterior rectal resection have become increasingly important. Our study demonstrates that the use of colonic pouch anastomosis gives a superior functional result when compared with traditional straight anastomosis for low rectal cancer. Therefore, colonic pouch anastomosis is a favorable option for patients undergoing low anterior or ultralow anterior resection.