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Multicenter Study
. 2023 Dec;27(12):1275-1287.
doi: 10.1007/s10151-023-02819-w. Epub 2023 May 29.

Comparison of anal function and quality of life after conformal sphincter preservation operation and intersphincteric resection of very low rectal cancer: a multicenter, retrospective, case-control analysis

G Sun #  1   2 , Y Zang #  3 , H Ding #  1 , Y Chen  4 , D Groothof  5 , H Gong  1 , Z Lou  1 , R Meng  1 , Z Chen  3 , E Furnee  2 , J Xiang  6 , W Zhang  7
Affiliations
Multicenter Study

Comparison of anal function and quality of life after conformal sphincter preservation operation and intersphincteric resection of very low rectal cancer: a multicenter, retrospective, case-control analysis

G Sun et al. Tech Coloproctol. 2023 Dec.

Abstract

Purpose: Conformal sphincter preservation operation (CSPO) is a sphincter preservation operation for very low rectal cancers. Compared to intersphincteric resection (ISR), CSPO retains more dentate line and distal rectal wall, and also avoids damaging the nerves in the intersphincteric space. This study aimed to compare the postoperative anal function and quality of life between the CSPO and ISR.

Method: Patients with low rectal cancer undergoing CSPO (n = 117) and ISR (n = 66) were included from Changhai and Huashan Hospital, respectively, between 2011 and 2020. A visual analog scale (range 0-10) was utilized to evaluate satisfaction with anal function and quality of life. The anal function was evaluated with Wexner scores and low anterior resection syndrome (LARS) score. Quality of life was evaluated with the EORTC QLQ-C30 and QLQ-CR38.

Results: The CSPO group had more male patients (65.8% vs. 50%, p = 0.042), more preoperative chemoradiotherapy (33.3% vs. 10.6%, p < 0.001), lower tumor position (3.45 ± 1.13 vs. 4.24 ± 0.86 cm, p < 0.001), and more postoperative chemotherapy (65% vs. 13.6%, p < 0.001) compared to the ISR group. In addition, CSPO patients had shorter postoperative stay (6.63 ± 2.53 vs. 7.85 ± 4.73 days, p = 0.003) and comparable stoma reversal rates within 1 year after surgery (92.16% vs. 96.97%, p = 0.318). Multivariable analysis showed that CSPO significantly contributed to higher satisfaction with anal function (beta = 1.752, 95% CI 0.776-2.728) and with quality of life (beta = 1.219, 95% CI 0.374-2.064), but not to Wexner, LARS score, or EORTC QLQ-C30 and QLQ-CR38.

Conclusion: CSPO improved the satisfaction with anal function and quality of life but utilized more preoperative chemoradiotherapy. CSPO may be an alternative choice for patients with very low rectal cancers in better physical health and with higher requirements for anal function and quality of life.

Keywords: Anal function; Conformal sphincter preservation operation; Intersphincteric resection; Outcome; Quality of life; Very low rectal cancer.

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Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Fig. 1
Fig. 1
Surgical procedures for CSPO (red line); total, subtotal, and partial ISR (blue lines). Adapted with permission from Sun et al. [4]
Fig. 2
Fig. 2
Patient flowchart
Fig. 3
Fig. 3
Comparison of the ileostomy reversal between the CSPO and ISR groups with log-rank test
Fig. 4
Fig. 4
Comparison of quality of life between CSPO (yellow) and ISR (blue) groups regarding a EORTC QLQ-C30 and b EORTC QLQ-CR38
See this image and copyright information in PMC

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