Sphincter saving rectum resection is the standard procedure for low rectal cancer

Abstract

All available evidence indicates that SSO should be the procedure of choice for rectal cancer, even in the lower one-third. An APER should only be performed when cancer invades the anal sphincters and negative resection margins cannot be achieved by a SSO.

Quality of life in patients after combined modality treatment of rectal cancer: Report of a prospective phase II study

“…Although the avoidance of a permanent stoma following rectal cancer excision is regarded as a favourable outcome measure, the bowel function after the sphincter-sparing procedures may be greatly altered, resulting in faecal urgency and incontinence. 10 Patients receiving preoperative radiochemotherapy for rectal cancer may develop also other unpleasant symptoms, such as micturition problems and sexual dysfunction. These symptoms, which occurred in a substantial proportion of patients, have been reported previously.…”

Role of intraoperative frozen section for assessing distal resection margin after anterior resection

“…Only two patients in the mid rectal group had positive margins managed by revised margins. These findings suggest that analysis of the distal margin is more critical depending on the distance from the anal verge [21,22]. As stated by other authors, we too suggest that APR should be reserved for patients in whom negative margins cannot otherwise be achieved.…”

Colonic Reservoirs in Patients After Rectal Resection

“…Currently, at least 1/5 of all rectal cancer patients treated with rectal resection still suffer from permanent injury in the form of abdominal fecal fistula (1) Studies of patients who have received low anterior resection and abdomino-perineal resection do not generally indicate a decline in life quality as a result of establishing such a permanent fecal fistula (2,3). Sphincter-sparing surgery is thought to be the treatment approach of choice in patients with effective sphincter apparatus, as long as infiltration of the sphincter muscles or structures of the bottom of the pelvis is not detected and R0 surgery can be performed safely (4).…”

“…Radiotherapy as an element of combined treatment of rectal cancer also contributes to impairing the efficiency of the sphincter apparatus (21,22), particularly to the internal sphincter (23,24). In cases of rectal cancer, the degree of sphincter impairment due to radiotherapy is similar to that of both pre-operative and post-operative irradiation (4).…”