Conformal proctectomy with sphincter preservation retains acceptable defecation functions in very low rectal cancer male patients

Abstract

Background: Conformal proctectomy with sphincter preservation (CPSP) is designed to preserve the rectal wall as much as possible in very low rectal cancer patients. Evaluations of anal function and quality of life outcomes are lacking.

Methods: This study included male patients with very low (≤ 5 cm from the anal verge) rectal adenocarcinoma between January 1, 2020, and January 1, 2022. A LARS score questionnaire survey and EORTC-QLQ-CR38 questionnaire survey were administered.

Results: A total of 21 very low rectal cancer patients were enrolled in follow-up. The average age of the patients was 56.7 years, the tumors were 1.9 ± 0.6 cm in size, and the distance from the anal verge was 4.8 ± 0.5 cm. All patients were followed up, and the mean follow-up period was 2.7 ± 0.5 years. The LARS score increased significantly from 4.1 ± 2.8 before surgery to 19.1 ± 6.0 at the 1^st year after surgery (P < 0.001) and then decreased to 13.1 ± 4.2 (P < 0.001) at the 2^nd year. The quality of life of patients was also lower at the 1^st year after surgery (61.1 ± 9.6 vs. 74.2 ± 11.2, P < 0.001) and was restored at the 2^nd year after surgery (80.6 ± 11.9 vs. 74.2 ± 11.2, P = 0.029). During standard follow-up at the outpatient department, no rectal tumor relapse was confirmed in these patients, although 2 patients were found to have suspected recurrence of local lymph node metastasis.

Conclusions: These results suggest that the CPSP technique preserves acceptable defecation function and is a safe and feasible option for male patients with very low rectal cancer.

Clinical trial registration: https://www.chictr.org.cn/, identifier ChiCTR2100052094.

Keywords: anal function; clinical trial; quality of life; rectal cancer; total mesorectal excision.

Figure 1

Patient selection for conformal proctectomy with sphincter preservation.

Figure 2

The sketch and operative picture of conformal proctectomy with sphincter preservation. (A), the sketch of conformal proctectomy with sphincter preservation. α, the angle between the cutting line and the dentate line. We recommend that the angle is 45°, and less than 60°. The width tumor involved should be less than 1/3 of rectal circumference. (B), the operative picture of conformal proctectomy with sphincter preservation. The rectum was mobilized according to the principle of total mesorectal excision until it reached the entrance of the intersphincteric space. Pull and stretch the rectum using laparoscopic bipolar forceps, and place endoscopic stapler at an angle (α) in the pelvic cavity to preserve more of the rectal wall.

Figure 3

EORTC-QLQ-C30 scores of the conformal sphincter preservation operation patients. The global health status, functional scales, symptom scales and single item measures before and after surgery were shown. An asterisk indicates significant differences. * means significant difference, P < 0.05.