Abstract
Low Rectal Cancers: Evolution from Abdominoperineal Resection (APR) to Sphincter Saving Procedures (SSP)
Highlights
Management of low rectal tumours is challenging for the surgeon as well as the patient as it involves subjecting the patient to a temporary, permanent or no stoma without compromising oncologic safety
Sphincter preservation with coloanal anastomosis in Low anterior resection (LAR) has become an established option for low rectal cancers, most patients with rectal cancer involving anal canal are routinely treated with Abdominal Perineal Resection (APR)
If we look at some of the largest clinical trials in rectal surgery, the aggregate percentage of patients subjected to APR is 39 % (Table 5) [15]
Summary
Management of low rectal tumours is challenging for the surgeon as well as the patient as it involves subjecting the patient to a temporary, permanent or no stoma without compromising oncologic safety. Surgery for low rectal cancer has gradually evolved towards more sphincter saving procedures (SSP), mainly as a result of a) Better understanding of cancer biology b) Improved surgical techniques c) Neo adjuvant therapy d) Use of surgical staplers. With the advent of advanced gadgets and better understanding of tumour characteristics, more and more patients are subjected to SSP instead of APR. Distal rectal cancers present a challenging task for surgeons in terms of providing a Sphincter Saving Procedure (SSP) as compared to Abdominal Perineal Resection (APR) and maintaining oncological safety. APR used to be commonly performed surgery for distal rectal cancers, but because of better understanding of cancer biology, better surgical techniques, newer neoadjuvant therapies & advent of surgical staplers, SSP are being preferred by both surgeons & patients. Primary aim of our study was to determine the various types of surgical treatment options in practice for distal rectal tumours & to compare the trend of Abdominal perineal resection and Sphincter saving procedures in a high-volume centre
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