Abstract
Background. Rectal carcinoma constitutes a health problem, previously
managed with abdomino-perineal resection (APR) which has the impact of
poor patient quality of life. With the introduction of the concept of total
mesorectal excision (TME) and stapler technology, sphincter saving surgery
(SSS) with its better local control and functional status is a better choice
than APR. We tried to evaluate the operative safety, long-term oncologic
and functional outcomes of SSS in rectal carcinoma.
Patients and methods. Between October 2008 and October 2012, patients
with rectal carcinoma presented electively to Sohag University Hospital
underwent SSS based on sharp mesorectal excision in the form of anterior
resection, low anterior resection and intersphincteric resection were
evaluated. Patients were followed up for four years.
Results. A total of 60 patients underwent SSS, regarding operative
complications; there were 2 ureteric injuries and one bladder injury.
Postoperatively, anastomotic leakage occurred in 6.7% of cases. Local
recurrence and distant metastases were detected in 8.3% 13.3% respectively.
During follow-up, disease-free survival rate was 66.9%, overall survival rate
was 93%, 22% of patients had a degree of incontinence. 21.66% had
temporary bladder dysfunction. Sexual dysfunction became evident in 30%
of male patients.
Conclusion. SSS with TME provides a better alternative to APR in rectal
carcinoma when feasible.