Research progress of surgical treatment for ultra-low rectal carcinoma

doi:10.3877/cma.j.issn.1674-6899.2024.06.011

Abstract

Abstract:

Rectal tumors located within 2 cm from the dentate line are classified as ultra-low rectal cancer，with surgery being the primary treatment approach. In patients who have ultra-low rectal cancer invading the levator ani muscle or anal sphincter，abdominoperineal resection （APR） or extralevator abdominoperineal excision （ELAPE） are the most common surgical procedures performed. The “surgical waist” is an unavoidable issue with APR. In spite of ELAPE's ability to remove more levator ani muscle tissue，which reduces intraoperative perforation and local recurrences，it poses the greater challenge of reconstructing the pelvic floor. In recent years，There have been various modifications made to ELAPE in terms of surgical approach and positioning that have achieved satisfactory results in clinical applications，however the anus has not yet been preserved. As anatomical research and laparoscopic technology advance，sphincter-preserving surgeries such as intersphincteric resection （ISR） and transanal total mesorectal excision （taTME） have been increasingly performed. It is important to note，however，that sphincterpreserving surgeries have higher technical demands，a longer learning curve，and postoperative complications as well as long-term oncological outcomes still need to be evaluated clinically. The aim of this article is to review the research progress of surgical treatments for ultra-low rectal cancer，to provide clinical physicians with a reference for selecting appropriate surgical treatments.

Key words: Ultra-low rectal carcinoma, Abdominoperineal resection, Extralevator abdominoperineal excision, Intersphincteric resection, Transanal total mesorectal excision

Lingqi Kong, Xiangyun Zheng, Yanmao Zhu, Song Yang, Yingxue Pan, Huanhu Zhang. Research progress of surgical treatment for ultra-low rectal carcinoma[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(06): 373-379.

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