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Colorectal

E107: Outcomes of Low Anterior Resection and Coloanal Hand Sewn Anastomosis for Ultra-Low Rectal Cancer: An 8-Year Case Series Study

Introduction:

With increasing post-total neoadjuvant therapy (TNT) observation, justifying abdominoperineal resection (APR) for patients retaining sphincteric function is challenging, underscoring the need for strategies prioritizing preoperative preservation and negative intraoperative margins. This study examines a case series of ultra-low rectal cancer (ULRC) patients who underwent Low Anterior Resection (LAR) and Colo-Anal Anastomosis (CAA). We hypothesize that specific factors critically influence functional outcomes, and that LAR can be effectively utilized for sphincter preservation.

Methods:

We conducted a retrospective analysis on patients from 2016 to 2023 at a single institution. We targeted biopsy-confirmed ultra-low rectal cancer cases that either abutted or partially involved the sphincter and later underwent LAR. The primary outcome was functional status. We used Chi-Square and ANOVA for statistical analysis.

Results:

This study involved 15 participants (46.67% female, 53.33% male). Tumors commonly appeared 0-1 cm from the anal verge (40%), with prevalent sizes being 1-2 cm and >4 cm (33.33% each). All participants achieved negative proximal, circumferential, and distal margins; the average distal margin was 1 cm (SD 0.75 cm). Postoperatively, 26.67% maintained regular bowel function, 26.67% improved with pelvic rehab, and 26.67% required APR and ostomy due to severe bowel dysfunction; 20% didn't reverse ileostomy. Closer distal margin status correlated with worse bowel function (p = 0.02). Pre-operative bowel function predicted postoperative results (p = 0.01). Higher BMI linked to poorer postoperative function (p = 0.02).

Conclusions:

This study reveals factors affecting ULRC patient outcomes after LAR and CAA and emphasizes the importance of tailored management. After ileostomy reversal, patients adjust to new anatomy and may need pelvic rehab. With the right strategies, LAR is a viable option for Ultra-Low Rectal Carcinoma treatment.

Learning Objectives:

  • After reviewing, participants should understand post-total neoadjuvant therapy significance, APR justification challenges, and strategies for sphincteric preservation and negative margins.
  • Describe key factors, including distal margin, pre-op bowel function, and BMI, impacting post-op outcomes in Ultra-Low Rectal Cancer patients undergoing LAR and colo-anal anastomosis.
  • Learners should understand the importance of preoperative assessment and strategies for implementing personalized management in ULRC, as well as LAR's potential for sphincter preservation in Ultra-Low Rectal Carcinoma.