Sphincter-saving anastomosis for rectal cancer: an overview

Abstract

To review the role of sphincter-saving anastomosis in the treatment of low rectal cancer, through a review of literature, we consider the oncologic value and the impact on morbidity and mortality of abdominoperineal resection compared specifically to sphincter-saving procedures. We also review the functional results reported after sphinctersaving procedures. Sphincter-saving procedures are now considered to be the first therapeutic choice in the approach to low rectal cancer. This choice is based on both the appraisal of the oncologic validity of this option and also on the realization of the significant negative impact on the quality of life to patients after an abdominoperineal resection. Functional results after sphincter saving procedures seem to be related to the length of the remaining rectal stump and the addition of a colonic J-pouch and have been documented as beneficial. In conclusion our review supports the trend towards sphincter-saving procedures as a first choice in the treatment of low rectal cancer. Tumours located at or near the sphincter or the dentate line and preexisting incontinence still remain indications for abdominoperineal resection.