title: Levator-sphincter reinforcement after ultralow anterior resection in patients with low rectal cancer: the surgical method and evaluation of anorectal physiology.
abstract: OBJECTIVE
  To determine whether ultralow anterior resection with levator-sphincter reinforcement (uLAR-LSR), which is first introduced in the current study, offers functional preservation in patients with low rectal cancer.
  
  
  METHODS
  We assessed the functional outcomes in 56 of 61 consecutively enrolled patients who underwent uLAR-LSR. After rectal resection, levator-sphincter reinforcement (LSR) was performed by approximation of the dissected muscles. The functional outcomes were assessed preoperatively, and then 3, 12, and 24 months postoperatively.
  
  
  RESULTS
  There were no significant differences in the sphincter or high-pressure zone length between the preoperative and postoperative periods in the uLAR-LSR group (P = 0.298-0.981), which indicated functional preservation by the LSR. The percentage of patients with moderate to severe incontinence (>10 using the Wexner score) was significantly decreased at 24 months as compared to 3 months postoperatively (15.7 vs, 39.6%, P < 0.001). At the limited mean follow-up of 41 months, local recurrence had been detected in one patient (1.8%).
  
  
  CONCLUSIONS
  The uLAR-LSR method is a novel technical option, which maintains the anorectal function as well as accomplishing oncological safety during a short-term evaluation.
authors.affiliation: Department of Surgery, Asan Medical Center, Institute of Innovative Cancer Research, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, Republic of Korea. jckim@amc.seoul.kr
authors.forename: Jin Cheon
authors.initials: JC
authors.lastname: Kim
authors.forename: Chan Wook
authors.initials: CW
authors.lastname: Kim
authors.forename: Yong Sik
authors.initials: YS
authors.lastname: Yoon
authors.forename: Hae Ok
authors.initials: HO
authors.lastname: Lee
authors.forename: In Ja
authors.initials: IJ
authors.lastname: Park
mesh_terms: D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005242:Fecal Incontinence / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
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