Clinical assessment of short-term outcome of sphincter-sparing surgery in patients with low rectal carcinoma

Hokkam, Emad; Faisal, Mohamed; Shams, Mohamed; Gomaa, Ahmed; Fathey, Hamada

doi:10.4103/ejs.ejs_185_18

Clinical assessment of short-term outcome of sphincter-sparing surgery in patients with low rectal carcinoma

Authors

Abstract

Introduction
Surgical oncology was born in excessive radicalism, but modern oncological surgery has become organ sparing and restorative. On this track, surgery for low rectal cancer is shifting from the abdominoperineal resection to the sphincter-sparing procedure. The new technique eliminates the need for permanent stoma and should provide cure rates equal to the more aggressive types of resection. The main aim of this study is to evaluate early outcome of sphincter-sparing surgery in patients with low rectal cancer.
Patients and methods
One hundred and fifty-three patients with low rectal cancer were enrolled in this prospective study. The lesions in all patients were located within 8 cm from the anal verge, and all the patients have disease-free sphincter. They were subjected to sphincter-sparing surgeries and followed up for a period ranging from 6 to 24 months to assess the oncological and functional outcome of the procedures.
Results
The mean distance of rectal carcinoma was 6 cm (4–8 cm) from the anal verge. Neoadjuvant chemoradiotherapy was needed in 49 patients as they had locally advanced lesions (T3 and T4), whereas the remaining 104 patients underwent primary resection. The safety margin ranged between 1.5 and 1.9 cm in 25% of the patients, 2–2.9 cm in 44% of the patients, and 3–3.5 cm in 31% of the patients. The mean safety margin was 2.5 cm. No local recurrence was reported in any patient during the follow-up period. Anastomotic leak was noted in 3.9%, pelvic abscess in 4.6%, anastomotic stenosis in 11.8%, incisional hernia in 9.8%, and grade II incontinence after 6 months of closing the stoma in 5.9% of the patients.
Conclusion
Patients with low rectal cancer have the chance to preserve their anal sphincter and practice normal defecation after sphincter-sparing surgery. The procedure did not compromise local control and has accepted oncological and functional outcomes.

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