Levator-sphincter reinforcement after ultralow anterior resection in patients with low rectal cancer: the surgical method and evaluation of anorectal physiology.

PURPOSE: To determine whether ultralow anterior resection with levator-sphincter reinforcement (uLAR-LSR), which is first introduced in the current study, offers functional preservation in patients with low rectal cancer.

METHODS: We assessed the functional outcomes in 56 of 61 consecutively enrolled patients who underwent uLAR-LSR. After rectal resection, levator-sphincter reinforcement (LSR) was performed by approximation of the dissected muscles. The functional outcomes were assessed preoperatively, and then 3, 12, and 24 months postoperatively.

RESULTS: There were no significant differences in the sphincter or high-pressure zone length between the preoperative and postoperative periods in the uLAR-LSR group (P = 0.298-0.981), which indicated functional preservation by the LSR. The percentage of patients with moderate to severe incontinence (>10 using the Wexner score) was significantly decreased at 24 months as compared to 3 months postoperatively (15.7 vs, 39.6%, P < 0.001). At the limited mean follow-up of 41 months, local recurrence had been detected in one patient (1.8%).

CONCLUSION: The uLAR-LSR method is a novel technical option, which maintains the anorectal function as well as accomplishing oncological safety during a short-term evaluation.