[Sphincter-saving resection for low rectal cancer]

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Colorectal Surgery

Context:

• Achieving R0 resection, anal sphincter preservation, and local control are paramount in rectal cancer surgery.
• Ultra-low anterior resection (U-LAR) is standard for lower rectal cancer, often using stapled anastomosis for reconstruction.
• Sphincter preservation techniques include pull-through operations, U-LAR, intersphincteric resection (ISR), and external sphincter resection (ESR).

Purpose:

• To review sphincter-preserving surgical techniques for rectal cancer.
• To discuss the role of U-LAR, ISR, and ESR in maintaining anal function.
• To highlight the need for clarity on long-term oncologic outcomes and anal function after these procedures.

Summary:

• U-LAR, ISR, and ESR are advanced surgical options for rectal cancer, aiming to preserve anal sphincter function.
• While these techniques can reduce abdominoperineal resection rates, long-term oncologic outcomes and functional results require further investigation.
• Careful patient selection based on tumor characteristics and patient preference is crucial for successful application.

Impact:

• These sphincter-preserving approaches can significantly decrease the rate of abdominoperineal resection in very low rectal cancers.
• Improved understanding of long-term outcomes will refine surgical decision-making and patient counseling.
• Enhanced functional preservation contributes to a better quality of life for rectal cancer survivors.