[Influence of different sphincter-preserving surgeries on postoperative defecation function]

Area of Science:

• Colorectal surgery
• Oncology
• Gastroenterology

Background:

• Sphincter preservation in low rectal cancer surgery improves quality of life.
• Postoperative low anterior resection syndrome (LARS) significantly impacts patients, including fecal incontinence, urgency, and clustering.
• Despite advances, effective management of LARS remains a challenge.

Purpose of the Study:

• To review the impact of different surgical techniques for low rectal cancer on postoperative defecation function.
• To evaluate the efficacy of various bowel reconstruction methods in mitigating LARS.
• To identify current limitations and future directions in preserving bowel function after low rectal cancer surgery.

Main Methods:

• Literature review of surgical procedures for low rectal cancer, including low anterior resection (LAR), intersphincteric resection (ISR), and Parks procedure.
• Analysis of studies reporting on the incidence and severity of LARS following these procedures.
• Evaluation of evidence regarding the effectiveness of bowel reconstruction techniques (e.g., J pouch, end-to-side anastomosis, pouch reconstruction) in improving functional outcomes.

Main Results:

• Low anterior resection (LAR) is associated with a high incidence of LARS (up to 84.6%).
• Inter-sphincteric resection (ISR) generally results in worse postoperative function than LAR, with functional outcomes worsening with increased resection extent.
• While the Parks procedure may have inferior short-term function compared to LAR, gradual recovery is observed. Current bowel reconstructions have not significantly reduced LARS incidence or severity.

Conclusions:

• Current surgical approaches for low rectal cancer, including LAR and ISR, frequently lead to significant LARS.
• Modifications in bowel reconstruction, such as J pouches or pouch reconstructions, have not proven effective in reducing LARS.
• Significant improvements in preserving postoperative defecation function for patients with low rectal cancer are still needed, highlighting an unmet clinical need.