Oncological and functional outcomes of sphincter saving procedures versus abdominoperineal resection for low rectal cancer: A comparative prospective cohort study.

Background: Despite the advantages of sphincter-saving procedures (SSP), its oncologic and functional outcomes arestill questionable in low rectal cancer patients. This study was done to compare the oncologic and functional outcomes ofabdominoperineal resection (APR) and SSP.Patients and Methods: Forty-six low rectal cancer patients who underwent either APR or SSP were included in thisprospective cohort study. The SSP included either ‘intersphincteric resection’ (ISR) or ‘ultralow anterior resection’(ULAR). The two groups were compared regarding survival and quality of life. Additionally, a functional outcomecomparison was done between ULAR and ISR.Results: The 1-, 2-, and 3-year overall survival rates for APR were 100, 100, and 92.9%, respectively, compared with100, 84.6, and 84.6%, respectively, for the SSP group. During the same previous follow-up visits, the disease-free survivalrates for APR were 90.5, 84.8, and 84.8%, respectively, compared with 96, 85.3, and 56.9%, respectively, for the SSP. Themedian Wexner score was 0 in the ULAR group compared with 7.5 in the ISR group. The median Low anterior resectionsyndrome score was 11 in the ULAR group versus 25 in the ISR group. The stoma group was inferior to the non-stomagroup in terms of physical function, social, psychological, and body image affection.Conclusion: Sphincter preservation, including ULAR and ISR, can be used to treat low rectal malignancies with higherquality of life and oncologic outcomes similar to APR. However, before surgery, patients should be counselled about thepossibility of bowel dysfunction following ISR.