To compare the indications, advantages, and limitations of different surgical procedures for excising ultra-low rectal tumors while preserving anal function, specifically focusing on the challenges posed by their proximity to the anal verge.
Key Findings:
Six sphincter-preserving techniques identified: local excision, low anterior resection (LAR), intersphincteric resection (ISR), modified Bacon and Parks procedures, transanal total mesorectal excision (TaTME), and NOSES-PPS. Most techniques achieve satisfactory oncological outcomes, but postoperative anal function remains a significant concern, particularly with LARS.
Preliminary evidence suggests NOSES-PPS may better preserve anal function, though studies are limited and further research is needed.
Interpretation:
Optimal outcomes in sphincter-preserving surgery depend on patient selection, surgical expertise, and perioperative management.
Limitations:
Current studies have small sample sizes and lack large-scale trials, which complicates the reliability of the findings.
Heterogeneity in study designs and outcome measures complicates comparisons.
Conclusion:
Sphincter-preserving techniques for ultra-low rectal cancer can achieve good oncological outcomes, but careful consideration of functional outcomes, particularly anal function, is essential in surgical decision-making.
