Comparison of Functional and Oncological Outcome of Conformal Sphincter Preservation Operation, Low Anterior Resection, and Abdominoperineal Resection in Very Low Rectal Cancer: a Retrospective Comparative Cohort Study with Propensity Score Matching

Overview

Journal Langenbecks Arch Surg

Specialty General Surgery

Date 2023 May 24

PMID 37222797

Authors

Ge Sun

Zheng Lou

Kuo Zheng

Yuntao Chen

Hang Zhang

Rongbo Wen

Xianhua Gao

Ronggui Meng

Haifeng Gong

Chenguang Bai

Edgar J B Furnee

Wei Zhang

Affiliations

Soon will be listed here.

Abstract

Purpose: Conformal sphincter preservation operation (CSPO) procedure is a sphincter preservation procedure for preserving the anal canal function for very low rectal cancers. This study investigated the functional and oncological outcome of conformal sphincter preservation operation by comparing with low anterior resection (LAR) and abdominoperineal resection (APR).

Methods: This is a retrospective comparative study. Patients who received conformal sphincter preservation operation (n = 52), low anterior resection (n = 54), or abdominoperineal resection (n = 69) were included between 2011 and 2016 in a tertiary referral hospital. Propensity score matching was applied to adjust the baseline characteristics which may influence the choice of the surgical procedure.

Results: Twenty-one pairs of conformal sphincter preservation operation vs. low anterior resection and 29 pairs of conformal sphincter preservation operation vs. abdominoperineal resection were selected. The first group had a higher tumor location than the second group. Compared with the low anterior resection group, the conformal sphincter preservation operation group had shorter distal resection margins; however, no significant differences were identified in daily stool frequency, Wexner incontinence score, local recurrence, distant metastasis, overall survival, and disease-free survival between both groups. Compared with the abdominoperineal resection group, the conformal sphincter preservation operation group had shorter operative time and shorter postoperative hospital stay. No significant differences were identified in local recurrence, distant metastasis, overall survival, and disease-free survival.

Conclusion: Conformal sphincter preservation operation is oncologically safe compared to APR and LAR, and has similar functional findings to LAR. Studies comparing CSPO with intersphincteric resection should be performed.

References

Zbar A . Sir W. Ernest Miles. Tech Coloproctol. 2007; 11(1):71-4. DOI: 10.1007/s10151-007-0333-2. View

Rullier E, Laurent C, Bretagnol F, Rullier A, Vendrely V, Zerbib F . Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule. Ann Surg. 2005; 241(3):465-9. PMC: 1356985. DOI: 10.1097/01.sla.0000154551.06768.e1. View

Inoue Y, Kusunoki M . Resection of rectal cancer: a historical review. Surg Today. 2010; 40(6):501-6. DOI: 10.1007/s00595-009-4153-z. View

Hieda K, Cho K, Arakawa T, Fujimiya M, Murakami G, Matsubara A . Nerves in the intersphincteric space of the human anal canal with special reference to their continuation to the enteric nerve plexus of the rectum. Clin Anat. 2013; 26(7):843-54. DOI: 10.1002/ca.22227. View

Digennaro R, Tondo M, Cuccia F, Giannini I, Pezzolla F, Rinaldi M . Coloanal anastomosis or abdominoperineal resection for very low rectal cancer: what will benefit, the surgeon's pride or the patient's quality of life?. Int J Colorectal Dis. 2013; 28(7):949-57. DOI: 10.1007/s00384-012-1629-x. View

Prete F, Sebastiani R, Sammarco D, Prete F . [Role of intersphincter resection among the surgical options for cancer of the distal rectum]. Chir Ital. 2002; 53(6):765-72. View

Perez R, Juliao G . Rectal eversion for direct access to the distal resection margin: do we need another tool in the toolbox of rectal cancer surgery?. Tech Coloproctol. 2020; 24(10):989-990. DOI: 10.1007/s10151-020-02323-5. View

Ding H, Wang L, Sun G, Yu G, Gao X, Zheng K . Evaluation of the learning curve for conformal sphincter preservation operation in the treatment of ultralow rectal cancer. World J Surg Oncol. 2022; 20(1):102. PMC: 8966240. DOI: 10.1186/s12957-022-02541-1. View

Hayden D, Weiss E . Fecal incontinence: etiology, evaluation, and treatment. Clin Colon Rectal Surg. 2012; 24(1):64-70. PMC: 3140335. DOI: 10.1055/s-0031-1272825. View

10.

Benson A, Venook A, Al-Hawary M, Cederquist L, Chen Y, Ciombor K . Rectal Cancer, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2018; 16(7):874-901. PMC: 10203817. DOI: 10.6004/jnccn.2018.0061. View

11.

Schiessel R, Karner-Hanusch J, Herbst F, Teleky B, Wunderlich M . Intersphincteric resection for low rectal tumours. Br J Surg. 1994; 81(9):1376-8. DOI: 10.1002/bjs.1800810944. View

12.

Rullier E, Zerbib F, Laurent C, Bonnel C, Caudry M, Saric J . Intersphincteric resection with excision of internal anal sphincter for conservative treatment of very low rectal cancer. Dis Colon Rectum. 1999; 42(9):1168-75. DOI: 10.1007/BF02238569. View

13.

Shirouzu K, Ogata Y, Araki Y, Kishimoto Y, Sato Y . A new ultimate anus-preserving operation for extremely low rectal cancer and for anal canal cancer. Tech Coloproctol. 2003; 7(3):203-6. DOI: 10.1007/s10151-003-0036-2. View

14.

Akagi Y, Kinugasa T, Shirouzu K . Intersphincteric resection for very low rectal cancer: a systematic review. Surg Today. 2012; 43(8):838-47. DOI: 10.1007/s00595-012-0394-3. View

15.

Konanz J, Herrle F, Weiss C, Post S, Kienle P . Quality of life of patients after low anterior, intersphincteric, and abdominoperineal resection for rectal cancer--a matched-pair analysis. Int J Colorectal Dis. 2013; 28(5):679-88. DOI: 10.1007/s00384-013-1683-z. View

16.

Denost Q, Laurent C, Capdepont M, Zerbib F, Rullier E . Risk factors for fecal incontinence after intersphincteric resection for rectal cancer. Dis Colon Rectum. 2011; 54(8):963-8. DOI: 10.1097/DCR.0b013e31821d3677. View

17.

Broens P, Penninckx F, Ochoa J . Fecal continence revisited: the anal external sphincter continence reflex. Dis Colon Rectum. 2013; 56(11):1273-81. DOI: 10.1097/DCR.0b013e3182a42d16. View

18.

Kim N, Lim D, Yun S, Sohn S, Min J . Ultralow anterior resection and coloanal anastomosis for distal rectal cancer: functional and oncological results. Int J Colorectal Dis. 2001; 16(4):234-7. DOI: 10.1007/s003840100306. View

19.

Resegotti A, Silvestri S, Astegiano M, Deiro G, Ribaldone D, Cassine D . "Small is beautiful" A series of ileo-anal anastomoses performed with the 25 - mm circular stapler. Ann Ital Chir. 2016; 87:186-91. View

20.

Polese L, Vecchiato M, Frigo A, Sarzo G, Cadrobbi R, Rizzato R . Risk factors for colorectal anastomotic stenoses and their impact on quality of life: what are the lessons to learn?. Colorectal Dis. 2011; 14(3):e124-8. DOI: 10.1111/j.1463-1318.2011.02819.x. View