Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2025; 31(29): 110004
Published online Aug 7, 2025. doi: 10.3748/wjg.v31.i29.110004
Long-term efficacy and short-term outcomes of intersphincteric resection vs abdominoperineal resection in patients with ultra-low rectal cancer
Guan-Cong Wang, Jun-Xing Chen, Hong-Feng Pan, Kai Ye, Yin-Cong Guo, Ying Huang
Guan-Cong Wang, Yin-Cong Guo, Ying Huang, Department of Colorectal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, Fujian Province, China
Guan-Cong Wang, Hong-Feng Pan, Ying Huang, Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou 351000, Fujian Province, China
Jun-Xing Chen, Kai Ye, Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 363000, Fujian Province, China
Co-first authors: Guan-Cong Wang and Jun-Xing Chen.
Co-corresponding authors: Yin-Cong Guo and Ying Huang.
Author contributions: Wang GC, Ye K, Guo YC and Huang Y were responsible for protocol/project development; Wang GC, Chen JX, and Pan HF were responsible for data collection/management; Wang GC was responsible for data analysis; Wang GC was responsible for manuscript writing/editing; Wang GC and Chen JX contributed equally to this article, they are the co-first authors of this manuscript; Guo YC and Huang Y contributed equally to this article, they are the co-corresponding authors of this manuscript; all authors have reviewed the manuscript.
Supported by Natural Science Foundation of Fujian Province, No. 2023J011819.
Institutional review board statement: This study was reviewed and approved by the Medical Ethics Committee of Zhangzhou Affiliated Hospital of Fujian Medical University (Approval No. 2024 LWB376), the Medical Ethics Committee of Union Hospital of Fujian Medical University (Approval No. 2025KY036), and the Medical Ethics Committee of the Second Affiliated Hospital of Fujian Medical University (Approval No. 2022492). All methods were performed in accordance with relevant guidelines and regulations, including the Declaration of Helsinki.
Informed consent statement: The informed consent was waived by the Institutional Review Board.
Conflict-of-interest statement: The authors declare no competing interests.
Data sharing statement: All data obtained or analyzed during this study are included in the article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yin-Cong Guo, Chief Physician, Professor, Department of Colorectal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 59 Shengli West Road, Zhangzhou 363000, Fujian Province, China. fjzzgyc@126.com
Received: May 28, 2025
Revised: June 13, 2025
Accepted: July 8, 2025
Published online: August 7, 2025
Processing time: 70 Days and 0.7 Hours
Core Tip

Core Tip: As the largest propensity score-matched study comparing intersphincteric resection (ISR) and abdominoperineal resection (APR), we minimized selection bias by balancing 13 covariates across 803 patients (289 matched pairs). ISR demonstrated a 6.7% absolute improvement in 5-year overall survival (80.8% vs 74.1%, HR = 0.554, P = 0.004) and reduced local recurrence (9.5% vs 12.9%, P = 0.019), establishing its oncologic superiority. Despite higher anastomotic leakage rates (11.4% vs 1.0%), ISR significantly reduced total complications (29.4% vs 42.2%, P = 0.001) and hospitalization duration (9.8 days vs 12.9 days, P < 0.001), supporting its role as the preferred sphincter-preserving alternative to APR.