What is the advantage of rectal amputation with an initial perineal approach for primary anorectal carcinoma?

Abstract

Background: Rectal amputation (RA) remains an important surgical procedure for salvage despite advances in sphincter-preserving resection, including intersphincteric resection. The aim of this study was to compare shortand long-term outcomes of RA with an initial perineal approach to those of RA with an initial abdominal approach (conventional abdominoperineal resection (APR)) for primary anorectal cancer. Methods:We retrospectively analyzed the short-and long-term outcomes of 48 patients who underwent RA with an initial perineal approach (perineal group) and 21 patients who underwent RA with an initial abdominal approach (conventional group).Results: For the perineal group, the operation time was shorter than that for the conventional group (313 vs. 388 min, p = 0.027). The postoperative complication rate was similar between the two groups (43.8 vs. 47.6%, p = 0.766). Perineal wound complications (PWCs) were significantly fewer in the perineal group than in the conventional group (22.9 vs. 57.1%, p = 0.006). All 69 patients underwent complete TME, but positive CRM was significantly higher in the conventional group than in the perineal group (0 vs. 19.0%, p = 0.011). There were no significant differences in the recurrence (43.8 vs. 47.6%, p = 0.689), 5-year disease-free survival (63.7% vs. 56.7%, p = 0.665) and 5-year overall survival rates (82.5% vs. 66.2%, p = 0.323) between the two groups. Conclusion: These data suggest that RA with an initial perineal approach for selective primary anorectal carcinoma is advantageous in minimizing PWCs and positive CRMs. Further investigations on the advantages of this approach are necessary.

Transanal down-to-up dissection of the distal rectum as a viable approach to achieve total mesorectal excision in laparoscopic sphincter-preserving surgery for rectal cancer near the anus: a study of short- and long-term outcomes of 127 consecutive patients from a single Japanese institution

“…was suspected during mobilization of the distal rectum [27]. Second, with down-to-up dissections under direct vision, we could obtain an adequate distant margin from the end of the tumor.…”

Transanal down-to-up dissection of the distal rectum as a viable approach to achieve total mesorectal excision in laparoscopic sphincter-preserving surgery for rectal cancer near the anus: a study of short- and long-term outcomes of 123 consecutive patients from a single Japanese institution

“…We believe that transanal down-to-up dissections have some benefits. First, we could convert the procedure to rectal amputation whenever any direct invasion of the adjacent organs (such as the vagina, prostate, and seminal vesicles) was suspected during mobilization of the distal rectum [ 29 ]. Second, with down-to-up dissections under direct vision, we could obtain an adequate distant margin from the end of the tumor.…”

Transanal down-to-up dissection of the distal rectum as a viable approach to achieve total mesorectal excision in laparoscopic sphincter-preserving surgery for rectal cancer near the anus: A study of short- and long-term outcomes of 127 consecutive patients from a single Japanese institution

“…We believe that transanal down-toup dissections have some bene ts. First, we could convert the procedure to rectal amputation whenever any direct invasion of the adjacent organs (such as the vagina, prostate, and seminal vesicles) was suspected during mobilization of the distal rectum [27]. Second, with down-to-up dissections under direct vision, we could obtain an adequate distant margin from the end of the tumor.…”