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Predictive model for sphincter preservation in lower rectal cancer.

Yajnadatta Sarangi1, Ashok Kumar2

  • 1Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India.

World Journal of Clinical Oncology
|September 3, 2025
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Summary

Sphincter-preserving surgery (SPS) for low rectal cancer is feasible. Patient factors, tumor characteristics, and treatment response predict success, with AI aiding selection for optimal outcomes.

Keywords:
FactorsLow rectal cancerPredictive modelSphincter preservationSurgery

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Area of Science:

  • Oncology
  • Surgical Gastroenterology
  • Medical Diagnostics

Background:

  • Low rectal cancer presents surgical challenges due to proximity to the anal sphincter, often necessitating permanent colostomy.
  • Advances in surgical techniques and neoadjuvant therapies offer potential for sphincter-preserving surgery (SPS), but patient selection is critical.
  • Lack of consensus on predictive factors for SPS in low rectal cancer hinders optimal patient selection and surgical planning.

Purpose of the Study:

  • To identify clinical, anatomical, and molecular factors that predict the feasibility of sphincter-preserving surgery (SPS) in patients with low rectal cancer.
  • To support improved patient selection and surgical planning for better oncological and functional outcomes.
  • To establish evidence-based criteria for determining suitability for SPS in this patient group.

Main Methods:

  • A comprehensive literature search was performed using PubMed/MEDLINE databases.
  • Analysis focused on patient-related factors, anatomical considerations, imaging modalities, diagnostic tools, and neoadjuvant chemoradiotherapy.
  • The relevance of each factor in predicting SPS feasibility was critically analyzed based on current evidence.

Main Results:

  • Predictive factors include patient demographics, preoperative continence, comorbidities, tumor distance from the anal verge, and anal sphincter involvement.
  • Favorable response to neoadjuvant chemoradiotherapy, specific biomarkers (inflammatory, tumor, molecular), and AI-driven analysis are associated with successful SPS.
  • Tumor biology, including BRAF/KRAS mutations and microsatellite instability, influences prognosis and decision-making for SPS.

Conclusions:

  • Sphincter-preserving surgery (SPS) is achievable for low rectal cancer, contingent on patient factors, tumor anatomy, and biology.
  • Preoperative treatment response and validated biomarkers are crucial for selecting candidates for SPS.
  • Emerging technologies like Artificial Intelligence (AI) can enhance patient selection for optimal long-term outcomes in SPS for low rectal cancer.