Oncologic safety and bowel function after ultralow anterior resection with or without intersphincteric resection for low lying rectal cancer: Comparative cross sectional study
Ahmad Sakr MD
Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt
Search for more papers by this authorSeung Yoon Yang MD
Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorJae Hyun Kang MD
Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorMin Soo Cho MD
Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorYoon Dae Han MD
Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorByung Soh Min MD, PhD
Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorWaleed Thabet MD, PhD
Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt
Search for more papers by this authorHosam Ghazy Elbanna MD, PhD
Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt
Search for more papers by this authorMosaad Morshed MD, PhD
Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt
Search for more papers by this authorCorresponding Author
Nam Kyu Kim MD, PhD
Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Correspondence Nam Kyu Kim, Department of Surgery, Division of Colorectal Surgery, Yonsei University College of Medicine, 50-1, Yonsei-Ro, Seodaemun-Gu, Seoul 120-752, Korea.
Email: [email protected]
Search for more papers by this authorAhmad Sakr MD
Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt
Search for more papers by this authorSeung Yoon Yang MD
Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorJae Hyun Kang MD
Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorMin Soo Cho MD
Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorYoon Dae Han MD
Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorByung Soh Min MD, PhD
Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Search for more papers by this authorWaleed Thabet MD, PhD
Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt
Search for more papers by this authorHosam Ghazy Elbanna MD, PhD
Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt
Search for more papers by this authorMosaad Morshed MD, PhD
Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt
Search for more papers by this authorCorresponding Author
Nam Kyu Kim MD, PhD
Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Correspondence Nam Kyu Kim, Department of Surgery, Division of Colorectal Surgery, Yonsei University College of Medicine, 50-1, Yonsei-Ro, Seodaemun-Gu, Seoul 120-752, Korea.
Email: [email protected]
Search for more papers by this authorThis paper was accepted as: Oral presentation at the annual meeting Korean society of coloproctology(KSCP) 5-7th April 2019, Jeju, South Korea. Poster presentation at ASCRS meeting, 1-6th June, 2019 Cleveland Clinic, Ohio, USA. Poster presentation at ESCP meeting 25–27th September 2019, Vienna, Austria.
Abstract
Background
Despite acceptable oncologic outcomes of sphincter preserving surgeries for low rectal cancer, bowel dysfunction occurs. This study aimed to compare the oncologic and functional bowel outcomes between ultralow anterior resection (ULAR) and intersphincteric resection (ISR) for low rectal cancer.
Methods
One hundred sixty-four patients who underwent ULAR with or without ISR for low rectal cancer between December 2010 and May 2018 were included. The Wexner and Memorial Sloan Kettering Cancer Center (MSKCC) scores were used to evaluate the bowel function of patients. Overall survival (OS) and disease-free survival (DFS) were compared between patients.
Results
The ISR group had higher incidence of major fecal incontinence than the ULAR group (75.9% vs 49.3%; P = .016). The median Wexner score decreased from 12 to 9 (P = .062) at 1-year follow-up. However, the frequency and urgency/soilage subscales of MSKCC score improved significantly in the ULAR group. ISR and follow-up interval less than 1-year significantly increased the major incontinence risk. The OS in the ULAR and ISR groups was 91.4% and 91.7%. Whereas the DFS in both groups was 79% and 79.2%, respectively.
Conclusion
ULAR and ISR are comparable in oncologic outcomes. Severe bowel dysfunctions and major incontinence were noted in ISR group. Careful selection of patients is mandatory.
CONFLICT OF INTERESTS
The authors declare that there are no conflict of interests.
Open Research
All data generated or analyzed during this study is included in this article.
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