Abdominoperineal Resection and Low Anterior Resection in Very-Low Rectal Cancer Are Both Acceptable Approaches

Muldoon RL, Bethurum AJ, Gamboa AC, et al. Comparison of Outcomes of Abdominoperineal Resection vs Low Anterior Resection in Very-Low Rectal Cancer. J Gastrointest Surg. 2024.

Patients with rectal cancers located within 5 cm of the anal verge and no involvement of the rectal sphincter can be treated with low anterior colorectal excision (LAR) or abdominoperineal resection (APR).

A significant proportion of surgeons choose APR because of the belief that improved oncologic outcomes are associated with this procedure. LAR may not be used because of the risk for complications such as LAR syndrome (diarrhea and fecal incontinence).

The authors queried a national rectal cancer database to determine long-term (median 42.5 months) disease-free survival in patients with low rectal cancers (n = 431, with 154 undergoing APR).

The data analysis showed that tumor recurrence rate was 19.6%. Perioperative complications were common, occurring in 60% to 67% of all patients but with no difference between the two groups. Disease-free survival was 70% at 5 years and was similar in the comparison groups; there was no significant difference in hospital length of stay. Of note is the fact that long-term quality of life data were not reported.

The authors concluded that APR and LAR were acceptable approaches for patients with low rectal cancers that do not involve the rectal sphincter.