Sphincter preservation in patients with low rectal cancer: striking the right oncological balance

Federico Luvisetto,Karen Flashman,Marieke L W Rutgers,Jim S Khan,Awad Shamali

doi:10.1007/s12672-021-00400-1

Federico Luvisetto, Karen Flashman + Show 3 more

Open Access

https://doi.org/10.1007/s12672-021-00400-1

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Abstract

BackgroundThe surgical treatment options for low rectal cancer patients include the Abdominoperineal Resection and the sphincter saving Low Anterior Resection. There is growing evidence towards better outcomes for patients being treated with a Low Anterior Resection compared to an Abdominoperineal Resection.ObjectiveThe aim of this study was to evaluate the short term and oncological outcomes in low rectal cancer treatment.DesignThis is a retrospective cohort study of prospectively collected data.SettingRectal cancer patients from a single center in the United Kingdom.PatientsPatients included all low rectal cancer patients (≤ 6 cm from the anal verge) undergoing Low Anterior Resection or Abdominoperineal Resection between 2006 and 2016.Outcome measuresTo identify differences in postoperative complications and disease free and overall survival.ResultsA total of 262 patients were included for analysis (Low Anterior Resection n = 170, Abdominoperineal Resection n = 92). Abdominoperineal Resection patients were significantly older (69 versus 66 years), had lower tumours (3 versus 5 cm), received more neo-adjuvant radiation, had longer hospital stay and more complications (wound infections and wound dehiscence). Low Anterior Resections had a significantly higher number of harvested lymph nodes (17 versus 12) however there was no difference in nodal involvement and R0 resection rate. No significant difference was found for recurrence, overall survival and disease free survival.LimitationRetrospective review of cancer database and single center data.ConclusionIn the treatment of low rectal cancer Abdominoperineal Resection is associated with higher rates of postoperative complications and longer hospital stay compared to the Low Anterior Resection, with similar oncological outcomes.

Highlights

Once the classical paradigm for rectal cancer treatment was; ‘The lower the cancer, the worse its prognosis’
Long course chemoradiotherapy was given to T4 rectal cancers or those with a threatened or involved circumferential resection margin (CRM) on magnetic resonance imaging (MRI)
170 patients underwent LAR and 92 patients were treated with APER

Summary

Introduction

Once the classical paradigm for rectal cancer treatment was; ‘The lower the cancer, the worse its prognosis’. The surgical treatment options for low rectal cancer patients include the Abdominoperineal Resection and the sphincter saving Low Anterior Resection. There is growing evidence towards better outcomes for patients being treated with a Low Anterior Resection compared to an Abdominoperineal Resection. Objective The aim of this study was to evaluate the short term and oncological outcomes in low rectal cancer treatment. Outcome measures To identify differences in postoperative complications and disease free and overall survival. Results A total of 262 patients were included for analysis (Low Anterior Resection n = 170, Abdominoperineal Resection n = 92). Conclusion In the treatment of low rectal cancer Abdominoperineal Resection is associated with higher rates of postoperative complications and longer hospital stay compared to the Low Anterior Resection, with similar oncological outcomes

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