Handsewn versus stapled anastomoses in low rectal cancer resection
Research type
Research Study
Full title
A comparison of functional and physiological outcomes of handsewn versus stapled anastomoses in low rectal cancer resection with volumetric analysis
IRAS ID
150055
Contact name
Emile Tan
Contact email
Sponsor organisation
Chelsea & Westminster Hospital
Research summary
Previously, a cancer in the lowest part of the bowel (low rectum) meant that a patient would need to undergo an abdominoperineal excision (where the rectum and anal sphincter complex are removed in their entirety and a permanent stoma is formed). More recently it has been shown that that provided you can take away 1cm of the rectum below the cancer, this is enough to perform a curative operation, whilst allowing you to rejoin the two ends so that the bowel continuity is maintained. As the anastomosis (join) between the bowel and anal canal is so low, it is not possible to perform this join in the same way as you would with tumours higher up in the bowel (usually performed using a stapling device). Therefore, a hand-sewn anastomosis is performed instead from outside the anus. The achievement the 1cm of margin below the tumour may also necessitate the removal of part of the anal sphincter, which is left fully intact with a stapled anastomosis. We therefore propose to identify patients who have undergone either an anterior resection (stapled anastomosis) or a lower hand-sewn anastomosis (coloanal anastomosis) and compare how well their bowel functions following surgery. We will ask all patients to fill in a number of questionnaires discussing howel function, quality of life and if indicated, sexual function. In addition to this, they will undergo an ultrasound scan of their anal sphincter (endoanal ultrasound) in addition to testing how well the anal sphincter works (known as anorectal physiology testing). We will also perform a specialised MRI scan on all patients in order to assess pelvic floor function, and to measure the total volume of anal sphincter left in those who have undergone a coloanal anastomosis to see whether this has an impact on function.
REC name
London - Bromley Research Ethics Committee
REC reference
14/LO/1653
Date of REC Opinion
23 Sep 2014
REC opinion
Favourable Opinion