Clinico-physiological results after sphincter-saving resection for rectal carcinoma

Area of Science:

• Colorectal surgery
• Gastrointestinal function
• Oncology

Background:

• Rectal cancer resection significantly impacts postoperative bowel function.
• Different surgical techniques may lead to varying functional outcomes.
• Understanding these outcomes is crucial for patient quality of life.

Purpose of the Study:

• To evaluate and compare postoperative functional results after three rectal cancer resection techniques: anterior resection (AR), low anterior resection (LAR), and stapled colo-anal anastomosis (SCA).
• To assess the impact of surgical technique on symptoms like soiling, urgency, and evacuation, as well as anal manometric parameters.

Main Methods:

• Prospective evaluation of 92 patients undergoing AR, LAR, or SCA for rectal carcinoma.
• Utilized patient questionnaires and anal manometry at 1, 3, 6, and 12 months post-operation.
• Compared functional outcomes and manometric data across the three surgical groups.

Main Results:

• The stapled colo-anal anastomosis (SCA) group exhibited significantly poorer outcomes regarding soiling and urgency at 12 months.
• Incomplete evacuation was more frequent in the SCA and LAR groups.
• While anal sensation recovered in all groups, neorectal reservoir function and maximum tolerable volume did not fully recover in SCA and LAR groups, with SCA showing lower threshold volumes.

Conclusions:

• Surgical technique significantly influences postoperative bowel function after rectal cancer resection.
• Stapled colo-anal anastomosis is associated with inferior functional results compared to AR and LAR.
• The reservoir function of the neorectum, involving muscle and neural components, is vital for maintaining bowel function post-surgery.