Clinical Efficacy Of Intersphincteric Resection For Low Rectal Cancer Compared With Abdominoperineal Resection

Background & Objective:The latest data provided by the International Agency for Research on Cancer shows that colorectal cancer ranks third and second in cancer incidence and mortality in the world,respectively.Among digestive system tumors,colorectal cancer ranks first,and the age of onset also tends to be younger.Among colorectal cancers,rectal cancers account for a higher proportion,especially the low rectal cancers,accounting for 70% to 80% of the total number of rectal cancers.At present,abdominoperineal resection(APR)has been the standard operation for low rectal cancer,completely removes the rectum,and anal sphincter complex to radically resect the tumor,resulting in a permanent colostomy ineluctably.In recent years,intersphincteric resection(ISR)has been performed at more and more specialized institutions to extend the opportunity for anus preservation.Meanwhile,there are also potential risks associated with ISR,including the risk of tumor recurrence and problems with the patient’s anal function after surgery.To date,there are not many studies comparing the long-term oncological outcomes of ISR and APR and reporting the anal function of patients after ISR,and most of these studies have limitations.This study was to conpare the efficacy of ISR with APR for low rectal cancer.Data & Methods1.Patients who underwent low rectal cancer radical Surgery at the Guangzhou First People’s Hospital from January 2013 to January 2019 were involved in this study.2.The demographic data were collected and compared,such as age,gender,BMI,tumor location,surgical procedure,ASA score,etc.3.The operative and short-term recovery outcomes were compared,such as the operation time,intraoperative blood loss,postoperative anal exhaust time,postoperative recovery of soft diet time,postoperative complication rate and hospital stay.4.Oncological outcomes such as tumor stage,adjuvant chemotherapy,and follow-up data were compared.Survival curves were compared for overall survival,disease-free survival and local recurrence rate.The LARS score and Wexner score were used for follow-up assessment of postoperative anal function in ISR patients.5.Performed a comprehensive search on Pub Med,Embase and Cochrane databases to obtain comparative studies comparing ISR and APR,then extracted and analyzed data,and meta analysis was performed.Results1.Of the 74 patients who were involved in this study,43 underwent ISR surgery and 31 underwent APR surgery.2.There was no statistical difference in age,gender,BMI,ASA score and underlying disease between the ISR group and APR group(P>0.05).3.Operation time(261.8 versus 319.2min,P<0.01)and blood loss(185.8 vs.375mL,P<0.01)were significantly reduced in the ISR group compared with the APR group.Bowel movement,time to soft diet,postoperative hospital stay and postoperative30-days complication rate showed no significant statistical difference between the two groups(P>0.05).4.Similarly,the survival data showed no significant differences(P>0.05).LARS score(14.8±6.5)and Wexner score(5.9±2.7)showed that the overall anal function of patients after ISR was satisfactory.5.In the meta analysis,a total of 12 retrospective comparative studies were included,forest plot showed that the ISR group had a lower postoperative complication rate and a shorter postoperative hospital stay than the APR group.There were no significant differences in the survival and recurrence rate between the two groups.ConclusionsIn certain cases,ISR surgery is safe and feasible for low rectal cancer,with good surgical data and postoperative recovery compared with APR surgery,ISR surgery showed less blood loss and shorter operation time.At the same time,the long-term survival outcomes of the ISR and APR groups were similar,and the follow-up data showed that the anal sphincter function after ISR was generally satisfactory.In summary,ISR is a safe and feasible anal preservation procedure.