title: Treatment for early ultralow rectal cancer: pull-through intersphincteric stapled transection and anastomosis (PISTA) versus low anterior resection.
abstract: BACKGROUND
  The aim of this study was to compare the functional and oncologic results of pull-through intersphincteric stapled transection and anastomosis (PISTA) with low anterior resection (LAR) in the treatment for early ultralow rectal cancer.
  
  
  METHODS
  A total of 278 patients with early ultralow rectal cancer were retrospectively included and analyzed, with 136 in the PISTA group and 142 in the LAR group.
  
  
  RESULTS
  Gender, age, tumor diameter, distance from the dentate line to the inferior margin of the tumor, tumor stage, length of operation and postoperative complications were comparable in the two groups. Compared with the LAR group, the PISTA group had a more accurate distal transection site, a lower daily fecal frequency (6 (5-7) vs. 8 (7-9), p < 0.001) and a lower Wexner incontinence score (13 (10-14) vs. 14 (13-16), p < 0.001) 3 months after ileostomy reversal, and a higher rate of satisfactory fecal continence (97.1 % vs. 90.8 %, p = 0.043). The follow-up period of the PISTA group was similar to that of the LAR group (56 (30-81) months vs. 54 (30-80) months, p = 0.982). The PISTA group was associated with a lower local recurrence rate (2.2 % vs. 11.3 %, p = 0.003). Kaplan-Meier analysis also showed that the PISTA group was associated with longer overall survival (p = 0.018) and longer local recurrence-free survival (p = 0.004) than the LAR group, while distant metastasis-free survival (p = 0.896) was comparable in the two groups. Multivariate analysis identified lymph node metastasis (p < 0.001) and operation (PISTA vs. LAR, p = 0.031) as independent predictive factors for local recurrence-free survival.
  
  
  CONCLUSIONS
  PISTA is a technically simple, oncologically safe and functionally favorable procedure for the treatment for early ultralow rectal cancer.
authors.affiliation: Department of Colorectal Surgery of Changhai Hospital, Second Military Medical University, Shanghai, 200433, China. fugang416@126.com
authors.forename: C G
authors.initials: CG
authors.lastname: Fu
authors.forename: X H
authors.initials: XH
authors.lastname: Gao
authors.forename: H
authors.initials: H
authors.lastname: Wang
authors.forename: Z Q
authors.initials: ZQ
authors.lastname: Yu
authors.forename: W
authors.initials: W
authors.lastname: Zhang
authors.forename: E D
authors.initials: ED
authors.lastname: Yu
authors.forename: L J
authors.initials: LJ
authors.lastname: Liu
authors.forename: R G
authors.initials: RG
authors.lastname: Meng
mesh_terms: D000328:Adult; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005242:Fecal Incontinence / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D017792:Surgical Stapling