Sphincter saving rectum resection is the standard procedure for low rectal cancer

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Evidence-Based Medicine

Background:

• Determining the optimal surgical procedure for rectal cancer, especially low rectal cancer, is crucial for patient outcomes.
• Abdominoperineal excision (APER) and sphincter-saving operations (SSO) are primary surgical approaches.
• Comparative data is essential to guide clinical decision-making.

Purpose of the Study:

• To identify the preferred surgical procedure for rectal cancer, with a specific focus on low rectal cancer.
• To compare the efficacy and patient-reported outcomes of APER versus SSO.

Main Methods:

• A comprehensive literature search of comparative studies and national surveys published since 1990 was conducted.
• Thirty-four studies (Evidence Level C) involving 6,570 patients were analyzed.
• Outcomes assessed included operative risk, local disease control, survival rates, and quality of life.

Main Results:

• Postoperative morbidity and mortality rates are similar for APER and SSO, with mortality below 2%.
• Surgical approach (APER vs. SSO) did not significantly impact local disease control or survival.
• Quality of life is significantly poorer following APER compared to SSO.

Conclusions:

• Sphincter-saving operations (SSO) should be the standard procedure for rectal cancer, including tumors in the lower third of the rectum.
• Abdominoperineal excision (APER) should be reserved for cases where sphincter invasion prevents achieving negative resection margins with SSO.