Comparison of oncologic outcome of abdominoperineal resection versus sphincter saving resection for low lying rectal cancer

Purpose: The present study compares the peri/postoperative and oncological outcomes of abdominoperineal resections (APR) and sphincter saving resection (SSR) for low lying rectal cancer.Methods: Between January 2001 and December 2014, 176 patients who underwent SSR (n = 67) and APR (n = 109) for low rectal cancer, without stage IV, were retrieved from a retrospective database.Results: With a median follow-up of 66.5 months. The mean total number of harvested lymph nodes was 16.7 (SSR) versus 17.1 (APR) (P = 0.801). The advanced T stage was higher in the APR group (82.6%) versus the SSR group (55.2%) (P = 0.006). The positive rate of lymph nodes after surgery was significantly higher in the APR group (45.9%) versus SSR group (25.4%) (P < 0.05). The 5-year overall survival rates for SSR and APR were 87.3% and 67.6%, respectively (P < 0.005). The 5-year disease-free survival rate (DFS) was 83.6% (SSR) versus 65.5% (APR) (P = 0.002). The recurrence rate was higher in the APR group (34.9%) versus the SSR group (14.9%) (P = 0.004). Local recurrence rate was not different between the two groups. However, distant recurrence rate was significantly higher in the APR group (26.6% vs. 11.9%, P = 0.023). In multivariate analysis, node positive (N0 vs. N1-2) was an independent prognostic factor for DFS (P < 0.005).Conclusion: Based on the present data, SSR achieved better 5-year oncological outcome than APR. The positive lymph node ratio in the N stage after surgery was higher in the APR group and this seems to have an effect on the oncological outcomes of the APR group.

Phẫu thuật bảo tồn hậu môn điều trị ung thư trực tràng thấp tại Bệnh Viện Ung Bướu TPHCM

Purpose: To analyse changes in performing sphincter-saving resection procedures for low rectal cancer in HCMC Oncology Hospital in the last 15 years (2004-2019). Patients and Methods: Medical records of 17 cases of low rectal carcinoma operated on from January through Juin, 2019 in Surgery Department No 2, HCMC Oncology Hospital were studied retrospectively. Data were compared to that of cases of low rectal carcinoma also operated on in HCMC Oncology Hospital from January, 2000 through December, 2004 (2004 group). Results: Compared with 2004 group, the sphincter-saving resection rate significantly increased (53% vs 4%, p<0.001); although there were higher proportions of men (77% vs 36%, p=0.003) and of early stage patients (29% stage I vs 4%, p<0.001). Sphincter-saving resection procedures were performed for 53% low rectal cancer patients (95% CI: 28-77%). All patients with tumors more than 3cm from the anal verge were operated on with sphincter-saving resection procedures. Conclusion: There was a significant increment of sphincter-saving resection for low rectal cancer in HCMC Oncology Hospital in the last 15 years (2004-2019). It was not different from worldwide trends.

Comparison of Sphincter Saving Resection (SSR) & Sphincter Losing Abdominoperineal Resection (APR) in Very Low Rectal Cancer

Oncological outcomes of sphincter-saving resection (SSR) and sphincter losing abdominoperineal resection (APR) in 210 consecutive patients with very low-lying rectal cancer (i.e. lower margin of tumor is within 3.5 cm from the anal verge) were studied and compared. 54 (25.71%) patients underwent SSR and 156 (74.28%) patients underwent SLR-APR. The APR group comprised higher proportions of men (61.53% vs 55.5%, P =.049) and advanced-stage disease (P <.001). Preoperative chemoradiotherapy (PCRT) was administered in both the group with almost similar distribution (62.82 % vs 59.25%, P <.001). Overall, (the systemic and local) recurrence rates were almost similar i.e. 33.31% in SSR and 33.32% in APR. On stratification according to PCRT and pathologic stage, the mode of surgery did not affect the recurrence type. Moreover, recurrence-free survival (RFS) did not differ according to the mode of surgery in different cancer stages. Patients who were stratified according to cancer stage and PCRT also showed no differences in RFS according to the mode of surgery. The results of the study demonstrate that, regardless of PCRT administration, SSR is an effective treatment for very low rectal cancer. J Shaheed Suhrawardy Med Coll, June 2019, Vol.11(1); 3-8