Total anorectal reconstruction supported by electrostimulation gracilis neosphincter

Area of Science:

• Surgical Oncology
• Colorectal Surgery
• Pelvic Reconstruction

Background:

• Abdominoperineal resection (APR) for anorectal cancer often results in loss of fecal continence.
• Restoring continence is crucial for improving the quality of life in patients undergoing APR.
• Electrostimulated Graciloplasty (ES-TAR) is a reconstructive technique aiming to address this challenge.

Purpose of the Study:

• To review and update the outcomes of Total Anorectal Reconstruction with Electrostimulated Graciloplasty (ES-TAR).
• To evaluate ES-TAR when performed concurrently with or after abdominoperineal resection (APR).
• To assess the oncological and functional results of ES-TAR in anorectal cancer patients.

Main Methods:

• Retrospective study conducted at a university hospital.
• Inclusion of 98 consecutive anorectal cancer patients who underwent ES-TAR (88 synchronous with APR, 10 post-APR).
• Evaluation of continence in 61 patients with a median follow-up of 55 months.

Main Results:

• No mortality observed.
• 37% of patients experienced postoperative complications, without impacting survival or functional outcomes.
• 5-year survival rate was 61% (in 50 patients), with a 65% cumulative probability of survival (in 81 patients).
• Local recurrence rate was 16%.
• Continence was achieved in 87% of patients with chronic ES-TAR stimulation versus 69% with short-term stimulation.

Conclusions:

• ES-TAR is a safe and effective method for both treating anorectal cancer and restoring fecal continence.
• The procedure demonstrates favorable oncological outcomes with acceptable complication rates.
• ES-TAR can be considered a reliable alternative to sphincter-saving procedures for selected lower rectal cancer patients.