Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China.
Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Langenbecks Arch Surg. 2023 May 24;408(1):208. doi: 10.1007/s00423-023-02925-1.
Conformal sphincter preservation operation (CSPO) procedure is a sphincter preservation procedure for preserving the anal canal function for very low rectal cancers. This study investigated the functional and oncological outcome of conformal sphincter preservation operation by comparing with low anterior resection (LAR) and abdominoperineal resection (APR).
This is a retrospective comparative study. Patients who received conformal sphincter preservation operation (n = 52), low anterior resection (n = 54), or abdominoperineal resection (n = 69) were included between 2011 and 2016 in a tertiary referral hospital. Propensity score matching was applied to adjust the baseline characteristics which may influence the choice of the surgical procedure.
Twenty-one pairs of conformal sphincter preservation operation vs. low anterior resection and 29 pairs of conformal sphincter preservation operation vs. abdominoperineal resection were selected. The first group had a higher tumor location than the second group. Compared with the low anterior resection group, the conformal sphincter preservation operation group had shorter distal resection margins; however, no significant differences were identified in daily stool frequency, Wexner incontinence score, local recurrence, distant metastasis, overall survival, and disease-free survival between both groups. Compared with the abdominoperineal resection group, the conformal sphincter preservation operation group had shorter operative time and shorter postoperative hospital stay. No significant differences were identified in local recurrence, distant metastasis, overall survival, and disease-free survival.
Conformal sphincter preservation operation is oncologically safe compared to APR and LAR, and has similar functional findings to LAR. Studies comparing CSPO with intersphincteric resection should be performed.
保肛成形术（CSPO）是一种保留肛门功能的手术，适用于低位直肠癌。本研究通过与低位前切除术（LAR）和腹会阴切除术（APR）比较，研究了保肛成形术的功能和肿瘤学结果。
这是一项回顾性比较研究。2011 年至 2016 年期间，在一家三级转诊医院，纳入了接受保肛成形术（n=52）、低位前切除术（n=54）或腹会阴切除术（n=69）的患者。采用倾向评分匹配法调整可能影响手术方式选择的基线特征。
选择了 21 对保肛成形术与低位前切除术和 29 对保肛成形术与腹会阴切除术进行比较。第一组的肿瘤位置高于第二组。与低位前切除术组相比，保肛成形术组的远端切除边缘较短；然而，两组之间的每日排便次数、Wexner 失禁评分、局部复发、远处转移、总生存率和无病生存率无显著差异。与腹会阴切除术组相比，保肛成形术组的手术时间和术后住院时间较短。两组之间的局部复发、远处转移、总生存率和无病生存率无显著差异。
与 APR 和 LAR 相比，保肛成形术在肿瘤学上是安全的，并且与 LAR 的功能结果相似。应该进行 CSPO 与经括约肌间切除术比较的研究。
