Our short-term results in patients who underwent sphincter-saving trans-sphincteric surgery by excising the invasive proximal sphincteric segment due to advanced lower rectal cancer with external anal sphincteric invasion.

Abstract

Introduction: One of the most essential contraindications of the sphincter-saving surgery in lower rectal cancer cases operated with the intersphincteric dissection technique, which is the most commonly used sphincter-saving surgical method, is an external anal sphincteric invasion. This article includes the short-term results of the lower rectal cancer cases with external anal sphincteric invasion who underwent proximal segmental sphincteric excision while performing the sphincter-sparing rectal resection in the trans-sphincteric plane.

Patients and methods: Sphincter-sparing surgery by excising the invasive proximal sphincteric segment in the trans-sphincteric plane was performed in 8 male and 3 female patients with advanced lower rectal adenocarcinoma, whose external anal sphincter invasion was seen in the pre-operative magnetic resonance imaging results after neoadjuvant chemoradiotherapy.

Results: In the post-operative periods of the patients, perineal fistula developed at the anterior perineal incision line in four patients and anastomotic stenosis developed in three patients. Anastomotic stenosis developed patients were the patients who were already being followed up due to perineal fistula. No evidence of external sphincteric invasion was found in the post-operative histopathological evaluation of two patients. Post-operative anal manometric sphincteric pressure measurements revealed partial decreases in resting and maximal squeeze anal pressures. It was observed that the patients whose ileostomy was closed had adequate continence.

Conclusion: Despite high complication rates, it is possible to perform sphincter-preserving surgery with excision of the invasive proximal segment with trans-sphincteric surgery in locally advanced rectal cancer. Trans-sphincteric rectal resection techniques should be considered as alternative sphincter-saving surgical procedures in lower rectal cancer cases with external sphincteric invasion by considering that the invasive proximal segment can be resected.