Outcomes of Rectal Cancer Patients With Low Sphincter-Preserving Operations Compared to Patients With Abdominoperineal Resection

Abstract

The surgical management for low rectal cancer patients has evolved as a result of the introduction of preoperative chemoradiotherapy and innovative technical developments. As a result, abdominoperineal resection (APR) for low rectal cancer has decreased over time. Further, the introduction of intersphincteric resection and preoperative chemoradiotherapy has made it possible to proceed with sphincter preservation. However, the oncologic and functional outcomes of intersphincteric resection have been questioned because of the narrow radical margin and sphincter excision. We review the literature to evaluate the oncologic outcomes of sphincter-preserving surgery in low rectal cancer compared to abdominoperineal resection. The oncologic outcome of extended abdominoperineal resection, which was developed to improve result of surgical outcome for low rectal cancer, is also discussed. The present manuscript addresses the evidence that shows oncologic safety and acceptable functional outcomes of intersphincteric resection. Our review shows that intersphincteric resection should be considered as an established acceptable operation for the management of low rectal cancer. On the other hand, APR results in frequent positive circumferential margins, higher local recurrence rate compared to sphincter-preserving resection. Nonetheless, abdominoperineal resection was inevitable for some subset of patients; therefore, efforts to improve oncologic outcomes after abdominoperineal resection have to be made. Extended APR which considers tumor extensiveness and standardizes perineal surgical extent has been proposed and oncologic benefits as well as overall outcomes are being evaluated. The current trend appears to indicate that the rate of intershincteric resection is increasing while APR decreasing. However, a multidisciplinary approach to low rectal cancers should emphasize oncologic and overall outcomes independent of sphincter preservation.