Comparative Study between Classic Abdominoperineal Resection versus Sphincter Saving Techniques for Treatment of Low Rectal Cancer

Abstract

Introduction:  Intersphincteric resection of low rectal tumors.is a surgical technique extending rectal resection into the intersphincteric space. This procedure is performed by a synchronous abdominoperineal approach with mesorectal. excision and excision of the entire or part of the internal sphincter. Aim of the Work: is to evaluate the oncological and functional outcome of classic abdominoperineal resection (APR) compared to sphincter sparing ( intersphincteric  resection) (ISR) procedures. Patient: Group A patients (10 patients): who meet the criteria of ISR possibility and candidates for sphincter preserving procedures Group B patients (10 patients): Who didn’t meet the criteria to do ISR, were subjected to APR. The number of the patients in this short research article were small as it is a preliminary study. Methods: Total ISR involves complete excision of the internal sphincter. The cut line is at the intersphincteric groove. B. Subtotal ISR involves partial excision of the internal sphincter. The cut line is between the dentate line and the intersphincteric groove. C. Modified partial ISR the cut line is below the dentate line on one side of the tumor. On the opposite side of the tumor, the cut line is above the dentate line. D Partial ISR the cut line is at or above the level of the dentate line. Results: showed that after 6 months, out of 10 patients underwent ISR, 6 patients were highly satisfied with Grade I continence according to Kirwan’s grade. While 4 patients were Grade II, i.e.: Incontinent to flatus. Non significant difference in the rate of recurrence between the two groups. Conclusion:  In low rectal cancer, the sphincter preservation appears to have nearly the same oncologic outcome compared to APR,. However, patients with sphincter preservation have certainly demonstrated an indisputable better functional outcome, in terms of stoma avoidance and adequate continence.