Postoperative Bowel Function After SPS by Different Reconstruction Methods
Condition: Bowel; Functional Syndrome
MeSH terms: Irritable Bowel Syndrome
Study type: Interventional

Summary: 
      Colorectal cancer is one of the most common malignant tumors in the world. Surgery is still
      the main treatment for rectal cancer. With the popularization of stapler technology and the
      application of preoperative neoadjuvant therapy, more and more patients with rectal cancer
      have treated sphincter preservation surgery for rectal cancer. postoperative observation
      found that some patients with rectal cancer anus-preserving surgery had different degrees of
      defecation dysfunction after surgery, such as incontinence, tightness, increased frequency of
      bowel movements, and constipation. These clinical symptoms have been classified as "Low
      anterior resection syndrome (LARS)" in recent years.Now there is no treatment for
      LARS.Meanwhile,J-pouch and side-to-end anastomosis can help the patients,but there is few
      trials can prove this.This trial means to prove weather side-to-end anastomosis can improve
      bowel of rectal patients afer surgery.
    

Detailed description: 
      Colorectal cancer is one of the most common malignant tumors in the world. There are more
      than 1.7 million new cases worldwide each year, accounting for 9.7% of all cancers. Among
      them, 840,000 deaths, accounting for 8.5% of all cancer deaths, mortality Second only to lung
      cancer, liver cancer and gastric cancer. China is a country with high incidence of colorectal
      cancer, and its morbidity and mortality are the fifth highest in malignant tumors. Rectal
      cancer is the most common type of colorectal cancer. The incidence of rectal cancer in China
      is 14.0/100,000, which is the 7th cancer incidence rate in China.

      Surgery is still the main treatment for rectal cancer. With the popularization of stapler
      technology and the application of preoperative neoadjuvant therapy, more and more patients
      with rectal cancer have treated sphincter preservation surgery for rectal cancer. The
      proportion of permanent ostomy has dropped to 16.9% to 29% . With the popularity of TME
      principles worldwide, the standardized treatment of rectal cancer is becoming more and more
      stable, and the postoperative survival rate of patients is steadily increasing. However,
      postoperative observation found that some patients with rectal cancer anus-preserving surgery
      had different degrees of defecation dysfunction after surgery, such as incontinence,
      tightness, increased frequency of bowel movements, and constipation. These clinical symptoms
      have been classified as "Low anterior resection syndrome (LARS)" in recent years. The
      research on LARS is still in its infancy, and its pathogenesis, influencing factors,
      pathophysiology and other explorations are not deep enough. Behind the various symptoms of
      low anterior resection syndrome is a complex pathophysiological basis. The symptoms and
      severity are affected by many changes in intestinal anatomy, nerve injury, postoperative
      healing process, diet structure and psychological status. The risk factors associated with
      the onset of defecation dysfunction after rectal cancer anal sphincter preservation include
      radiotherapy, total mesorectal excision, and tumor location. The role of various risk factors
      in the pathogenesis of defecation dysfunction after rectal cancer anal sphincter preservation
      is still controversial. At present, the diagnosis, grading and treatment of LARS are still in
      the exploration stage, and there is still no effective treatment.

      Since the 1980s, a variety of colon-rectal anastomosis methods have been used in clinical
      practice to improve the dysfunction of rectal cancer after anal sphincter preservation,
      including J-pouch anastomosis, Colon transverse anastomosis, and end-to-side anastomosis.
      Each of the above three methods has its advantages and disadvantages: J-type storage bag
      improves the postoperative bowel movement anastomosis effect, but the technique is
      complicated and has more anastomotic symptoms; the colon transverse of the colon has a wide
      application range but the effect of improving the defecation function is poor; It has the
      longest history, but the time to apply to functional protection is the shortest, and there
      are few studies. Huttner et al published a meta-analysis published in 2015 (including 1636
      cases from 21 clinical trials reports. Compared with end-to-end anastomosis, J-pouch can
      reduce the frequency of defecation and antidiarrheal drugs after 1 year after surgery.
      Similar results have been achieved with end-to-side anastomosis and colonic angioplasty; a
      review published by Brown et al also suggests that J-pouch can reduce the frequency of
      defecation and urgency of bowel movements during early (0-8 months) and mid-term (8-18
      Months) .The end-to-side anastomosis achieved similar effects in each stage of the J-pouch,
      so it can be inferred that the end-to-side anastomosis (relative to end-to-end anastomosis)
      can improve postoperative defecation function. A retrospective study of end-to-end
      anastomosis and end-to-end anastomosis published in China also found that end-to-side
      anastomosis can reduce bowel movements and improve postoperative defecation function at 6
      months after surgery. However, there is still no prospective clinical trial comparing the
      end-to-side anastomosis and end-to-end anastomosis for postoperative intestinal function. The
      ideal anastomosis should meet the characteristics of exact effect, simple operation and low
      complications. The end-to-side anastomosis is one of the potential choices, but its validity
      and safety lack relevant research evidence and need further study.
    

Intervention name(s): different reconstruction methods
Intervention type(s): Procedure
Intervention description(s): Different reconstruction methods should be performed after sphincter preservation surgery in two groups.The methods include end-to-end anastomosis or end-to-side anastomosis
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Bowel Function; Sphincter Preservation Surgery; Reconstruction Method