A new sphincter-preserving operation for low rectal cancer: ultralow anterior resection and colorectal/coloanal anastomosis by supporting bundling-up method.
OBJECTIVE
The introductions of total mesorectal excision and double-stapling technique into colorectal surgery have promoted the clinical application of sphincter preservation. However, for the tumors localized on the middle or lower level of rectum, sphincter-preservation approaches might be problematic in some patients. We introduce in this report a new sphincter-preserving technique for low rectal cancer.


METHODS
Between August 1999 and May 2004, 310 patients underwent ultralow anterior resection and colorectal/coloanal anastomosis by supporting bundling-up method for low rectal cancer localized in the lower third of rectum. Postoperative evaluation included anal function, anastomotic leakage, anastomotic stenosis, cumulative survival rate, and local recurrence.


RESULTS
Three hundred ten patients received the sphincter-preserving operation without severe intraoperative complications. One patient died of lung dysfunction (0.3%). All patients had satisfactory anal function without soiling. The median follow-up was 84 months (9-136 months) and overall survival rate was 97.0% at 1 year, 73.5% at 3 years, and 66% at 5 years. Thirty-six patients (11.6%) patients developed local recurrence. Postoperative complications included anastomotic leakage (1.6%), anastomotic stenosis (2.5%), and local and distant recurrence (11.6% and 18.4%, respectively).


CONCLUSIONS
Ultralow anterior resection and colorectal/coloanal anastomosis by supporting bundling-up method may be one of the best choices of sphincter-preserving operation for low rectal cancer.
Han
Fanghai
F
Department of Gastrointestinopancreatic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Li
Hongming
H
Zheng
Donghua
D
Gao
Hongkai
H
Zhang
Zhaoda
Z
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods*; D003106:Colon / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005242:Fecal Incontinence / Q000145:classification / Q000150:complications / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000503:physiopathology; D011183:Postoperative Complications / Q000503:physiopathology; D012004:Rectal Neoplasms / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016019:Survival Analysis; D055815:Young Adult