Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China.
Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands.
Tech Coloproctol. 2020 Oct;24(10):1025-1034. doi: 10.1007/s10151-020-02229-2. Epub 2020 May 2.
Conformal sphincter preservation operation (CSPO) is a new surgical procedure for very low rectal cancers (within 4-5 cm from the anal verge). CSPO preserves more of the dentate line and distal rectal wall and also avoids injuring nerves in the intersphincteric space, resulting in satisfactory anal function after resection. The aim of this study was to analyze the short-term surgical results and long-term oncological and functional outcomes of CSPO.
Consecutive patients with very low rectal cancer, who had CSPO between January 2011 and October 2018 at Changhai Hospital, Shanghai were included. Patient demographics, clinicopathological features, oncological outcomes and anal function were analyzed.
A total of 102 patients (67 men) with a mean age of 56.9 ± 10.8 years were included. The median distance of the tumor from the anal verge was 3 (IQR, 3-4) cm. Thirty-five patients received neoadjuvant chemoradiation (nCRT). The median distal resection margin (DRM) was 0.5 (IQR, 0.3-0.8) cm. One patient had a positive DRM. All circumferential margins were negative. There was no perioperative mortality. The postoperative complication rate was 19.6%. The median duration of follow-up was 28 (IQR, 12-45.5) months. The local recurrence rate was 2% and distant metastasis rate was 10.8%. The 3-year overall survival and disease-free survival rates were 100% and 83.9%, respectively. The mean Wexner incontinence and low anterior resection syndrome scores 12 months after ileostomy reversal were 5.9 ± 4.3, and 29.2 ± 6.9, respectively.
For patients with very low rectal cancers, fecal continence can be preserved with CSPO without compromising oncological results.
保肛成形术（CSPO）是一种新的手术方法，适用于非常低位的直肠癌（距离肛门边缘 4-5cm 以内）。CSPO 可以保留更多的齿状线和直肠远端壁，并且避免损伤肛门内括约肌间隙中的神经，从而在切除后获得满意的肛门功能。本研究旨在分析 CSPO 的短期手术结果以及长期的肿瘤学和功能结果。
回顾性分析 2011 年 1 月至 2018 年 10 月在上海长海医院接受 CSPO 的连续低位直肠癌患者的临床病理特征、肿瘤学结果和肛门功能。
共纳入 102 例（67 例男性）患者，平均年龄为 56.9±10.8 岁。肿瘤距肛门边缘的中位距离为 3（IQR，3-4）cm。35 例患者接受了新辅助放化疗（nCRT）。中位远端切缘（DRM）为 0.5（IQR，0.3-0.8）cm。1 例患者 DRM 阳性。所有环周切缘均为阴性。无围手术期死亡。术后并发症发生率为 19.6%。中位随访时间为 28（IQR，12-45.5）个月。局部复发率为 2%，远处转移率为 10.8%。3 年总生存率和无病生存率分别为 100%和 83.9%。肠造口还纳术后 12 个月，Wexner 失禁和低位前切除综合征评分的平均得分为 5.9±4.3 和 29.2±6.9。
对于低位直肠癌患者，CSPO 可以保留排便功能，而不会影响肿瘤学结果。
