RCT on Postoperative Bowel Function Following SPS by Different Reconstruction Methods
RCT on Postoperative Bowel Function Following SPS by Different Reconstruction Methods
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.
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.
Inclusion Criteria:

 -  The rectal adenocarcinoma is proved by pathology before surgery

 -  The lower margin of the tumor is less than 12cm higher from the anal verge under no
 anesthesia measured

 -  The tumor can be excised discussed by MDT

 -  Anus preserving operation can be performed

 -  ECOG score ranges between 0 and 2

 -  The estimate life is supposed to be more than 12 months

 -  The informed consent should be signed

 Exclusion Criteria:

 -  The patient can not follow the experimental scheme

 -  The case is an emergency

 -  The patient is in pregnant or breast-feeding

 -  TME surgery can not be performed

 -  One-stage anastomosis can not be performed

 -  The patient has a history of anus surgery or rectal surgery

 -  The patient has a history of left hemicolectomy

 -  The patient has a long history of bowel dysfunction，such as diarrhea or dysporia
 before surgery

 -  The patient has cognitive disorder or communication disorder

 -  The patient has repeat infection or other disorders poorly controlled

 -  The patient joins other clinical trail that may disturb the bowel function