Sphincter Preservation
with George Apostolides, MD
How does a J-pouch work?
Sphincter preservation is one of the newest treatments for rectal cancer and in some cases, allows patients to avoid a permanent colostomy. At GBMC, physicians perform the procedure to remove rectal cancer, while protecting the rectum and allowing patients to return to daily life without complications.
According to George Apostolides, MD, Division Head of Colon and Rectal Surgery at GBMC, sphincter preservation allows patients to keep a portion of their rectum, which helps them retain bowel function that is close to average. The treatment is no longer considered experimental and past clinical studies show the preservation treatment is as effective in cancer treatment as traditional procedures. The best candidates for the preservation treatment are those whose cancer has not gone through the bowel wall.
Before the new procedure, rectums were routinely removed during rectal cancer surgery and patients were given a permanent colostomy, an opening of the bowel through the abdominal wall, allowing stool to be collected in an external bag. “The first question a patient often asks when diagnosed with rectal cancer is ‘can you preserve my rectum?’” says Dr. Apostolides.
During surgery, the surgeon enters a patient’s abdomen, removes the rectum to below the location of the tumor and attaches the colon directly to the anal sphincter. The entire procedure generally takes three to four hours. “With new technology, we can save the rectum and do not have to remove it completely,” says Dr. Apostolides.
At GBMC, physicians are committed to offering the best and most advanced treatments for patients. “There is a technique that creates a new rectum by folding the bowel on itself or creating a new reservoir with the colon before it is attached to the anal sphincter,” says Dr. Apostolides.
This emerging procedure, sometimes known as a J-pouch or coloplasty, helps restore normal bowel function. “Before, when people had their rectums removed, there was a straight connection of the colon and anal sphincter and without a pouch, people could move their bowels six to ten times per day. With this new technique, patients have two to three bowel movements per day, which is close to normal,” says Dr. Apostolides. “This is a major improvement and people are much more comfortable.”
Physicians at GBMC are also utilizing more sophisticated diagnostic techniques. “We can study patients very accurately prior to surgery with a special ultrasound. We select those who are the best candidates for sphincter preservation surgery and are able to give them hope for a good cancer surgery and result,” says Dr. Apostolides. Treatment decisions may also be based on the stage and location of cancer as well as the age and gender of the patient.
Although some patients may require a temporary colostomy bag after surgery, these new advancements are dramatically improving long-term outcomes. “As recently as a few years ago, the classic treatment for rectal cancer was to remove the rectum and give patients a permanent colostomy,” says Dr. Apostolides. “This new treatment can give patients a better quality of life.”
