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. 2017 Aug 14;1(3):199-207.
doi: 10.1002/ags3.12032. eCollection 2017 Sep.

Local control of sphincter-preserving procedures and abdominoperineal resection for locally advanced low rectal cancer: Propensity score matched analysis

Ryosuke Okamura  1 , Koya Hida  1 , Tomohiro Yamaguchi  2 , Tomonori Akagi  3 , Tsuyoshi Konishi  4 , Michio Yamamoto  5 , Mitsuyoshi Ota  6 , Shuichiro Matoba  7 , Hiroyuki Bando  8 , Saori Goto  1 , Yoshiharu Sakai  1 , Masahiko Watanabe  9 ; Japan Society of Laparoscopic Colorectal Surgery; Kazuteru Watanabe  1   2   3   4   5   6   7   8   9 , Koki Otsuka  1   2   3   4   5   6   7   8   9 , Ichiro Takemasa  1   2   3   4   5   6   7   8   9 , Keitaro Tanaka  1   2   3   4   5   6   7   8   9 , Masataka Ikeda  1   2   3   4   5   6   7   8   9 , Chu Matsuda  1   2   3   4   5   6   7   8   9 , Meiki Fukuda  1   2   3   4   5   6   7   8   9 , Junichi Hasegawa  1   2   3   4   5   6   7   8   9 , Shintaro Akamoto  1   2   3   4   5   6   7   8   9 , Manabu Shiozawa  1   2   3   4   5   6   7   8   9 , Atsushi Tsuruta  1   2   3   4   5   6   7   8   9 , Takashi Akiyoshi  1   2   3   4   5   6   7   8   9 , Takeshi Kato  1   2   3   4   5   6   7   8   9 , Shunsuke Tsukamoto  1   2   3   4   5   6   7   8   9 , Masaaki Ito  1   2   3   4   5   6   7   8   9 , Masaki Naito  1   2   3   4   5   6   7   8   9 , Akiyoshi Kanazawa  1   2   3   4   5   6   7   8   9 , Takao Takahashi  1   2   3   4   5   6   7   8   9 , Takashi Ueki  1   2   3   4   5   6   7   8   9 , Yuri Hayashi  1   2   3   4   5   6   7   8   9 , Satoshi Morita  1   2   3   4   5   6   7   8   9 , Takashi Yamaguchi  1   2   3   4   5   6   7   8   9 , Masayoshi Nakanishi  1   2   3   4   5   6   7   8   9 , Hirotoshi Hasegawa  1   2   3   4   5   6   7   8   9 , Ken Okamoto  1   2   3   4   5   6   7   8   9 , Fuminori Teraishi  1   2   3   4   5   6   7   8   9 , Yasuo Sumi  1   2   3   4   5   6   7   8   9 , Jo Tashiro  1   2   3   4   5   6   7   8   9 , Toshimasa Yatsuoka  1   2   3   4   5   6   7   8   9 , Yoji Nishimura  1   2   3   4   5   6   7   8   9 , Kenji Okita  1   2   3   4   5   6   7   8   9 , Takaya Kobatake  1   2   3   4   5   6   7   8   9 , Hisanaga Horie  1   2   3   4   5   6   7   8   9 , Yasuyuki Miyakura  1   2   3   4   5   6   7   8   9 , Hisashi Ro  1   2   3   4   5   6   7   8   9 , Kunihiko Nagakari  1   2   3   4   5   6   7   8   9 , Eiji Hidaka  1   2   3   4   5   6   7   8   9 , Takehiro Umemoto  1   2   3   4   5   6   7   8   9 , Hideaki Nishigori  1   2   3   4   5   6   7   8   9 , Kohei Murata  1   2   3   4   5   6   7   8   9 , Fuminori Wakayama  1   2   3   4   5   6   7   8   9 , Ryoji Makizumi  1   2   3   4   5   6   7   8   9 , Shoichi Fujii  1   2   3   4   5   6   7   8   9 , Eiji Sunami  1   2   3   4   5   6   7   8   9 , Hirotoshi Kobayashi  1   2   3   4   5   6   7   8   9 , Ryosuke Nakagawa  1   2   3   4   5   6   7   8   9 , Toshiyuki Enomoto  1   2   3   4   5   6   7   8   9 , Shinobu Ohnuma  1   2   3   4   5   6   7   8   9 , Jun Higashijima  1   2   3   4   5   6   7   8   9 , Heita Ozawa  1   2   3   4   5   6   7   8   9 , Keigo Ashida  1   2   3   4   5   6   7   8   9 , Fumihiko Fujita  1   2   3   4   5   6   7   8   9 , Keisuke Uehara  1   2   3   4   5   6   7   8   9 , Satoshi Maruyama  1   2   3   4   5   6   7   8   9 , Masato Ohyama  1   2   3   4   5   6   7   8   9 , Seiichiro Yamamoto  1   2   3   4   5   6   7   8   9 , Takao Hinoi  1   2   3   4   5   6   7   8   9 , Masanori Yoshimitsu  1   2   3   4   5   6   7   8   9 , Masazumi Okajima  1   2   3   4   5   6   7   8   9 , Shu Tanimura  1   2   3   4   5   6   7   8   9 , Masayasu Kawasaki  1   2   3   4   5   6   7   8   9 , Yoshihito Ide  1   2   3   4   5   6   7   8   9 , Shoichi Hazama  1   2   3   4   5   6   7   8   9 , Jun Watanabe  1   2   3   4   5   6   7   8   9 , Daisuke Inagaki  1   2   3   4   5   6   7   8   9 , Akihiro Toyokawa  1   2   3   4   5   6   7   8   9
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Local control of sphincter-preserving procedures and abdominoperineal resection for locally advanced low rectal cancer: Propensity score matched analysis

Ryosuke Okamura et al. Ann Gastroenterol Surg. .

Abstract

Sphincter-preserving procedures (SPPs) for surgical treatment of low-lying rectal tumors have advanced considerably. However, their oncological safety for locally advanced low rectal cancer compared with abdominoperineal resection (APR) is contentious. We retrospectively analyzed cohort data of 1500 consecutive patients who underwent elective resection for stage II-III rectal cancer between 2010 and 2011. Patients with tumors 2-5 cm from the anal verge and clinical stage T3-4 were eligible. Primary outcome was 3-year local recurrence rate, and confounding effects were minimized by propensity score matching. The study involved 794 patients (456 SPPs and 338 APR). Before matching, candidates for APR were more likely to have lower and advanced lesions, whereas SPPs were carried out more often following preoperative treatment, by laparoscopic approach, and at institutions with higher case volume. After matching, 398 patients (199 each for SPPs and APR) were included in the analysis sample. Postoperative morbidity was similar between the SPPs and APR groups (38% vs 39%; RR 0.98, 95% CI 0.77-1.27). Margin involvement was present in eight patients in the SPPs group (one and seven at the distal and radial margins, respectively) and in 12 patients in the APR group. No difference in 3-year local recurrence rate was noted between the two groups (11% vs 14%; HR 0.77, 95% CI 0.42-1.41). In this observational study, comparability was ensured by adjusting for possible confounding factors. Our results suggest that SPPs and APR for locally advanced low rectal cancer have demonstrably equivalent oncological local control.

Keywords: intersphincteric resection; local recurrence; rectal cancer; sphincter preservation.

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Figures

Figure 1
Figure 1
Study population. Flowchart of patient enrolment
Figure 2
Figure 2
Cumulative incidence of local recurrence for matched sample of patients undergoing sphincter‐preserving procedures (SPPs) and abdominoperineal resection (APR)
Figure 3
Figure 3
Subgroup analysis of local recurrence for matched sample of patients undergoing sphincter‐preserving procedures (SPPs) and abdominoperineal resection (APR). AV, anal verge; CI, confidence interval; HR, hazard ratio; LLN, lateral pelvic lymph node
See this image and copyright information in PMC

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