Rectal Cancer - Sphincter Saving Techniques

Abstract

Background: Rectal cancer management has as its main component the surgical treatment. The purpose of the paper is to point out the advantages and disadvantages of sphincter saving techniques, respecting the oncological principles. Material and method: A cross-sectional, retrospective study was performed on a group of 69 patients admitted and surgically treated for rectal cancers in the Surgical Clinic I of the County Emergency Clinical Hospital of Tîrgu Mureș, for a period of one year (April 2012 -April 2013 and to whom rectal resections were performed. We followed the immediate postoperative evolutions in these patients, making a comparative analysis between those with the sphincter saving surgery and those in which other operations were performed. Results: From the total of 69 patients diagnosed with rectal cancer, sphincter saving procedures with restoration of digestive continuity by coloanal anastomosis were performed in 12 patients (17.39%) using the peranal or transanal approach; in 42 patients (60.86%) anterior rectosigmoidian resections with low and very low colorectal anastomosis ("very low" Dixon procedure) were performed. In 15 cases (21.74%) the Miles type of rectal resections, using the abdomino-perineal way, were performed. Out of the 12 cases with peranal or transanal anastomosis, 4 cases had postoperative complications. Conclusions: Rectal resection procedures, which are restoring the digestive tract continuity using low anastomosis (colorectal, coloanal, peranal or transanal), are representing viable and "physiological" alternatives, if they respect the oncologic principles. In well selected cases, the immediate postoperative evolution is favorable, relieving the patient from the psychological and physical trauma due to the presence of a colostomy.