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[Sphincter saving procedure for low rectal carcinoma]

K Sugihara1, Y Moriya, T Akasu

  • 1Department of Surgery, National Cancer Center Hospital, Tokyo, Japan.

Nihon Geka Gakkai Zasshi
|March 1, 1997
PubMed
Summary
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Sphincter-saving procedures (SSP) offer better prognosis and survival rates for rectal cancer patients compared to abdominoperineal resection (APR). While SSPs show fewer recurrences and metastases, functional outcomes require improvement.

Area of Science:

  • Colorectal Surgery
  • Surgical Oncology
  • Gastrointestinal Oncology

Background:

  • Sphincter-saving procedures (SSP) are oncologically viable for rectal cancer when adequate margins are achieved.
  • Abdominoperineal resection (APR) is often reserved for more advanced cases.

Purpose of the Study:

  • To compare the oncological outcomes and functional results of SSP versus APR for low rectal carcinomas.
  • To evaluate the efficacy of SSP in rectal cancer treatment.

Main Methods:

  • Retrospective analysis of 209 rectal carcinoma patients treated between 1984-1993.
  • Comparison of SSP (114 patients) and APR (95 patients) based on tumor characteristics, invasion depth, lymph node metastasis, recurrence rates, survival, and metastasis incidence.
  • Functional outcomes assessed by comparing SSP with anterior resection for mid/upper rectal cancers.

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Main Results:

  • The APR group had more advanced tumors (p=0.011) and lymph node metastases (p=0.059).
  • SSP group showed significantly lower recurrence rates (17.5% vs 30.5%, p=0.027) and better 5-year survival (80.2% vs 70.0%, p=0.0007).
  • Hematogenous metastases were less frequent in the SSP group (13.2% vs 26.3%), with no difference in local recurrences. Functional outcomes after SSP were comparable to anterior resection, with common complaints of altered bowel function.

Conclusions:

  • SSP provides acceptable oncological outcomes for selected low rectal carcinomas.
  • While SSP demonstrates superior survival and lower recurrence rates than APR, functional deficits necessitate further improvement strategies.