Retrospective study of the functional and oncological outcomes of conformal sphincter preservation operation in the treatment of very low rectal cancer

Abstract

Background Conformal sphincter preservation operation (CSPO) is a new surgical procedure for very low rectal cancers (within 4–5 cm from the anal verge). CSPO preserves more of the dentate line and distal rectal wall and also avoids injuring nerves in the intersphincteric space, resulting in satisfactory anal function after resection. The aim of this study was to analyze the short-term surgical results and long-term oncological and functional outcomes of CSPO. Methods Consecutive patients with very low rectal cancer, who had CSPO between January 2011 and October 2018 at Changhai Hospital, Shanghai were included. Patient demographics, clinicopathological features, oncological outcomes and anal function were analyzed. Results A total of 102 patients (67 men) with a mean age of 56.9 ± 10.8 years were included. The median distance of the tumor from the anal verge was 3 (IQR, 3–4) cm. Thirty-five patients received neoadjuvant chemoradiation (nCRT). The median distal resection margin (DRM) was 0.5 (IQR, 0.3–0.8) cm. One patient had a positive DRM. All circumferential margins were negative. There was no perioperative mortality. The postoperative complication rate was 19.6%. The median duration of follow-up was 28 (IQR, 12–45.5) months. The local recurrence rate was 2% and distant metastasis rate was 10.8%. The 3-year overall survival and disease-free survival rates were 100% and 83.9%, respectively. The mean Wexner incontinence and low anterior resection syndrome scores 12 months after ileostomy reversal were 5.9 ± 4.3, and 29.2 ± 6.9, respectively. Conclusions For patients with very low rectal cancers, fecal continence can be preserved with CSPO without compromising oncological results.

The Safety and Feasibility of Laparoscopic Surgery for Very Low Rectal Cancer: A Retrospective Analysis Based on a Single Center’s Experience

“…The median length of an anal canal is 3 to 4 cm from the anal verge [ 23 ]. In the current study, we defined rectal cancer that was located <5 cm from the anal verge as very low rectal cancer [ 23 , 24 , 25 ]. We measured the tumor location for all patients with rigid proctosigmoidoscopy at the time of initial diagnosis.…”

Evaluation of the learning curve for conformal sphincter preservation operation in the treatment of ultralow rectal cancer

“…Considering the anatomic characteristics of the anal canal, the Department of Colorectal Surgery, Shanghai, Changhai Hospital, proposed the CSPO [ 11 – 13 ] for ultralow rectal cancer. As a new anal-preserving operation, it combined with total mesorectal excision (TME) [ 14 , 15 ], coloanal anastomosis [ 16 ], eversion pull-through resection [ 17 ], anal canal dissection, local tumor resection [ 18 ], natural orifice translumenal endoscopic surgery (NOTES) [ 19 ], and so forth.…”

Evaluation of the Learning Curve for Conformal Sphincter Preservation Operation in The Treatment of Ultra-Low Rectal Cancer

“…Considering the anatomic characteristics of the anal canal, Department of Colorectal Surgery, Shanghai Changhai Hospital proposed the CSPO [11][12][13] for ultra-low rectal cancer. As a new anal-preserving operation, it combined with total mesorectal excision [14][15] (TME), coloanal anastomosis [16], eversion pull-through resection [17], anal cannal dissection, local tumor resection [18], natural ori ce translumenal endoscopic surgery [19] (NOTES) and so forth.…”

“…By April 2020, we have completed 123 cases of CSPO. The favorable oncology and functional prognosis of patients with CSPO has gradually been con rmed by relevant studies in our center and relevant literature has also been published [11][12][13].…”