Pull-through and conformal resection for very low rectal cancer: a more satisfactory technique for anal function after sphincter preserving operation

Background: The aim of this study was to investigate oncologically whether pull-through and conformal resection technique (PTCR) could replace abdominoperineal resection (APR) in selected patients with very low rectal cancer. Methods: This was a retrospective review of prospectively collected data. The study was conducted at a tertiary teaching hospital, Shanghai, China from January 2010 to December 2013. All patients who underwent operations because of very low rectal cancer were enrolled in this study. The primary outcome measured was the development of recurrence including distant metastasis and local recurrence. Anal function was assessed with the Wexner incontinence score and digital examination. Results: A total of 228 patients with very low rectal cancer underwent surgical treatment [coloanal anastomosis (CAA) group 126 patients, APR group 73 patients, and PTCR group 29 patients]. There was no difference in surgical complication rate among the three groups. There were no significant differences in daily fecal frequency, Wexner incontinence score, and rate of satisfactory fecal continence between the CAA and PTCR group. There were no differences in local recurrence and distant metastasis among CAA group, APR group and PTCR group. Conclusions: PTCR is an anus-preserved procedure with clean distal margin and satisfied anal function without compromising short-term oncological outcomes in selected patients with very low rectal cancer.