1997 Volume 30 Issue 10 Pages 2112-2116
This study was designed to determine the reasonable length of the colon to be resected for right side colon and rectal cancers from the viewpoint of radicality and postoperative function. After right hemicolectomy or ileocecal resection, patients had frequent stools, 11% took antidiarrhoeal drugs, and 18% complained of abdominal symptoms. These complications could be caused by resection of the ileocecal junction. Our findings on lymph-node metastasis of right side colon cancer were as follows. Lymph-node spread along the bowel was not above 5 cm from the tumor. Intermedite nodal metastasis was to either between the right branch of the middle colic artery and the right colic artery, or between the right colic artery and the ileocolic artery. Retrograde metastasis were very rare in the principal nodes. Therefore, preserving the ileocecal junction may be feasible in radicality and valuable for function, in cancer near the hepatic flexure. And we obtained good results by ileocecal junction-preserving right hemicolectomy. We performed a barium enema study of the neoreclum after low anterior resection. Patients with a straight type neorectum had very frequent stools while those with a winding type neorectum like a physiological rectum had good postoperative function. As far as possible the sigmoid colon should be preserved for a neorectum with good function. Our data show that lymphnodal oral side cancer that spread more than 10 cm along the rectum wall accounted for 0.5% of advanced lower rectal cancers. Reconstruction of the neorectum using a long sigmoid colon may be possible for curability and give good postoperative function. We achieved good practical results in low anterior resection by preserving the sigmoid colon.
