Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jul 15, 2015; 7(7): 55-70
Published online Jul 15, 2015. doi: 10.4251/wjgo.v7.i7.55
Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes
Nikoletta Dimitriou, Othon Michail, Dimitrios Moris, John Griniatsos
Nikoletta Dimitriou, Othon Michail, Dimitrios Moris, John Griniatsos, 1st Department of Surgery, University of Athens, Medical School, Laiko Hospital, 11527 Athens, Greece
Author contributions: Dimitriou N and Griniatsos J designed the study; Michail O and Moris D analyzed the data, drafted the manuscript; Dimitriou N wrote the paper; and Griniatsos J corrected the manuscript and made the final approval.
Conflict-of-interest statement: Authors have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: John Griniatsos, Associate Professor of Surgery, 1st Department of Surgery, University of Athens, Medical School, Laiko Hospital, 17 Agiou Thoma Street, 11527 Athens, Greece. johngriniatsos@yahoo.com
Telephone: +30-210-7456855 Fax: +30-213-2061766
Received: January 28, 2015
Peer-review started: February 1, 2015
First decision: March 6, 2015
Revised: March 28, 2015
Accepted: May 26, 2015
Article in press: May 27, 2015
Published online: July 15, 2015
Processing time: 166 Days and 16.6 Hours
Abstract

Low rectal cancer is traditionally treated by abdominoperineal resection. In recent years, several new techniques for the treatment of very low rectal cancer patients aiming to preserve the gastrointestinal continuity and to improve both the oncological as well as the functional outcomes, have been emerged. Literature suggest that when the intersphincteric resection is applied in T1-3 tumors located within 30-35 mm from the anal verge, is technically feasible, safe, with equal oncological outcomes compared to conventional surgery and acceptable quality of life. The Anterior Perineal PlanE for Ultra-low Anterior Resection technique, is not disrupting the sphincters, but carries a high complication rate, while the reports on the oncological and functional outcomes are limited. Transanal Endoscopic MicroSurgery (TEM) and TransAnal Minimally Invasive Surgery (TAMIS) should represent the treatment of choice for T1 rectal tumors, with specific criteria according to the NCCN guidelines and favorable pathologic features. Alternatively to the standard conventional surgery, neoadjuvant chemo-radiotherapy followed by TEM or TAMIS seems promising for tumors of a local stage T1sm2-3 or T2. Transanal Total Mesorectal Excision should be performed only when a board approved protocol is available by colorectal surgeons with extensive experience in minimally invasive and transanal endoscopic surgery.

Keywords: Low rectal cancer; Sphincter preserving surgery; Intersphincteric resection; Anterior Perineal PlanE for Ultra-low Anterior Resection of the Rectum; Total mesorectal excision; TransAnal Minimally Invasive Surgery; Transanal Total Mesorectal Excision; Quality of life; Oncological outcome; Functional outcome

Core tip: The present review presents the most recent advances in the field of sphincter preserving surgery for the treatment of low rectal cancer patients, providing indications, patients’ selection, surgical techniques, multimodality approaches, postoperative course and oncological and functional outcomes. In particular, the review focuses on data deriving from prospective studies, systematic reviews and meta-analyses. The conclusion makes clear that a customized approach based on current guidelines, as well as specific pathological prognostic factors, is mandatory for obtaining the maximum favorable outcome in each patient.