Short And Long-term Outcomes Of Low Rectal Cancer Sphincter-preserving Surgery

BACKGROUND:Abdominal Perineal Resection (APR) is the surgical standard for Low Rectal Cancer(LRC) management. However, The improvement in surgical techniques alongside neoadjuvant chemoradiation enabled more patients with low rectal cancer to have sphincter preservation.STUDY AIM:1. To compare the clinical, pathological and surgical information in patients with low rectal cancer treated by sphincter-preserving radical resection (SPRR) against those who underwent abdomino-perineal resection (APR), and to evaluate the sphincter function of the patients who underwent SPRR.2. To review the short-term and long-term outcomes of sphincter-preserving resection(SPR), and to discuss the feasibility of SPR in the management of low rectal cancer patients.STUDY METHODS:1. A total of 82 patients with low rectal cancer underwent surgical resection in NO.2 affiliated hospital of Zhejiang University during Apr 2014 to Sep 2015, which include 39 patients who retrospectively underwent SSRR and a group formed of 43 patients who underwent APR. All lesions were<5 cm from anal verge. The clinical, pathological and surgical data of SSRR and APR patients was compared.2. The PubMed database was searched for studies and relevant literature written in English which were published between 2005 and 2015 regarding SPR for LRC. Studies with median follow-up more than 36 months, sample size bigger than 40, all patients who underwent SPR and confirmed with LRC(within 5 cm from the anal verge) and available long-term outcomes were included and summarized.RESULTS:1. The median follow-up was 23 months (range 1-60 months) for both groups. The difference in operation time (P=0.738), detected number of lymph nodes (P=0.442), inpatient time after operation (P=0.593), post-operation complications (P=0.349) and mortality (P=0.506) between the SSRR and APR groups were statistically insignificant. The amount of bleeding of APR group was significantly higher than SPRR group (P=0.010)and the location of tumors were lower(P< 0.001). The local recurrence rates of SPRR group and APR group were 13% and 7% respectively, distant metastasis rates were 9% and 17%, and 1-year overall survival(OS) 91.3% and 90.9%,with no significant difference(P=0.189,P=0.588 and P=0.960). the average daily defecation frequency of SPRR group were 3.67±1.79, Wexner score 4.06±2.49, the satisfaction of defaecation continence was 61.1%. satisfaction of defaecation continence was 61.1%.2. According to the summary of studies during last decade, the complication rate of SPR was generally 18.1%,the motality was 0.09%, the local recurrence rate was 5.9% and the distant metastasis rate was 10.5% with the median follow-up of 53.4 (0-168) months.3-year and 5-year OS were 93.1% and 87.8% respectively.CONCLUSION:In low rectal cancer, the sphincter preservation appears to have nearly the same oncologic outcome compared to APR. Patients with sphincter preservation have certainly demonstrated an indisputable better functional outcome, in terms of stoma avoidance and adequate continence. Therefore, SPR is safe and feasible in selected LRC patients, with acceptable short-term and long-term outcomes.