Quality of life after Abdominoperineal excision of the rectum vs intersphincteric resection in patients with low rectal malignancy

Abstract

Introduction: Intersphincteric resection of low rectal tumors is a surgical technique extending rectal resection into the intersphincteric space. This procedure is performed by a synchronous abdominoperineal approach with mesorectal excision of the entire or part of the internal sphincter.
Objectives: is to evaluate the quality of life after surgery in patients with low rectal malignancy, the classic abdominoperineal resection (APR) compared to sphincter sparing (intersphincteric resection) (ISR) procedures.
Methods: This was an observational clinical study at Beni-Suef University hospital in Egypt for 6 months on patients diagnosed with low rectal malignant growth with clinical stages II (cT3-4, N0, M0) and III (cT1-4, N+, M0) based on histopathology. 20 patients were allocated in to 2 equal groups: ISR group (A) and APR group (B) according to operation technique. Intraoperative complications were recorded. The follow up of the patients was done every three months up to one year for post-operative complications and recurrence rate. Continence was evaluated in ISR group after 6 months using kirwan’s grades.
Results: Overall the rate of complications in the ISR group was higher than APR group with no statistical significant difference. The follow up of the patients showed non-significant difference concerning recurrence rates between both groups. For the ISR group, 30% cases showed recurrence without distant metastasis, while 20% in the APR group showed local recurrence, one of them with distant metastasis. In ISR group after 6 months; 60% of patients were highly satisfied with Grade I continence according to Kirwan’s grade, while 40% patients were Grade II.
Conclusion: In low rectal cancer, Patients with sphincter preservation have demonstrably shown enhanced functional results in terms of stoma avoidance and good continence.