Early Functional Outcome of Neorectum Reservoirs in Patients with Low Rectal Cancer

Background: Rectal cancer ranks as the eighth most common cancer globally and the eighth leading cause of cancer-related mortality. In Egypt, colorectal cancer is the seventh most common cancer, accounting for 3.47% of cancers in males and 3% in females. Colonic J-pouch is one type of anastomosis in which Colonic reservoirs following proctectomy have been developed to overcome the functional limitations of straight coloanal anastomoses. Research has shown that creation of a colonic reservoir improves postoperative function by increasing the volume capacity of the neorectum. Aim: This study aims to assess improvement in quality of life and evaluate early functional outcome of neorectal reservoirs in patients with low rectal cancer by restoring bowel function and continuity after rectal surgery. Setting: Suez Canal University Hospital and Kobry El Kobba military hospital. Methods: This is prospective, observational, comparative study included 60 patients diagnosed with low rectal cancer who underwent surgery involving neorectum reservoir reconstruction over a period of 2 year. According to the type of neorectum reservoirs constructed, these 60 patients were assigned into three groups: Group 1: Side-to-end Anastomosis (SEA, n=19) Group 2: Transverse Coloplasty Pouch (TCP, n=20) Group 3: Colonic J-Pouch (CJP, n=21). All patients among the three groups underwent a neorectum reservoir procedure, and outcomes were compared to determine differences in early functional recovery. Results: The study found that the CJP technique provided significantly superior functional outcomes. Patients in the CJP group had significantly lower daily bowel frequency both early postoperatively (median 3 vs. 4 in SEA/TCP; p=0.04) and at 3-6 months (median 2 vs. 3 in SEA/TCP; p=0.02). This translated into a significantly lower (better) LARS score (median 15 vs. 25 in SEA; p=0.01). These subjective findings were supported by objective anorectal manometry, which showed significantly higher mean basal pressure (55 ± 8 mmHg) and mean squeeze pressure (110 ± 15 mmHg) in the CJP group (p=0.01 for both). Conclusion: While all three reconstructive techniques are safe and feasible, the Colonic J-pouch offers distinct and significant advantages in early functional outcomes, quality of life, and postoperative recovery. Based on these findings, CJP should be considered the preferred reconstructive option for eligible patients undergoing sphincter-preserving surgery for low rectal cancer.