Case-matched comparison of intersphincteric proctectomy versus proctectomy with stapled coloanal anastomosis for low rectal cancer

Abstract

Background: The role of intersphincteric proctectomy in low rectal cancer remains controversial. Objective: To compare the perioperative and oncologic outcomes of intersphincteric proctectomy to proctectomy with stapled coloanal anastomosis. Design: A retrospective case-matched review. Setting: A tertiary colorectal surgery unit. Patients and Methods: All intersphincteric proctectomy cases conducted by one surgeon over a 7-year period were matched for gender, race, age, and comorbidities with patients who underwent proctectomy with stapled coloanal anastomosis. Main Outcome Measures: Operative time, blood loss, postoperative complications, length of stay, margin status, lymph node harvest, and local recurrence rate. Sample Size: Thirty-four patients. Results: Group A (intersphincteric) 17 and Group B (stapled) 17 were compared. Mean age was 57.2 years (12 males and 5 females in each group). All patients received neoadjuvant chemoradiation and underwent diverting ileostomy. Estimated blood loss was higher in Group A (771 ml vs. 327 ml, P < 0.05). Similarly, operative time was longer in Group A (295 vs. 235 min, P < 0.05). No difference was noted in postoperative complication rate between Group A and B (29.4% vs. 17.6%, P = 0.688). Length of stay was similar in both groups (6.9 vs. 6.3 days, P = 0.565). There was no difference in radial or distal margin positivity (0%, both groups) or lymph node harvest. Distal margin was longer in Group B (3.7 vs. 1.6 cm, P = 0.007). During a mean follow-up of 22 months, the local recurrence rate was 0%. Conclusions: Intersphincteric proctectomy was associated with higher blood loss and longer operative time compared to stapled coloanal anastomosis. Immediate and long-term oncologic outcomes were comparable. Limitations: A single surgeon experience, retrospective study, and small number of patients. Conflict of Interest: None.