Ann Coloproctol.  2020 Jul;36(3):148-154. 10.3393/ac.2018.07.19.

Early and Late Functional Outcomes of Anal SphincterSparing Procedures With Total Mesorectal Excision for Anorectal Adenocarcinoma

• eldamshety O
• Kotb S
• Khater A
• Roshdy S
• Elashry M
• Zahi MS
• Elkalla HMHR
• Elnahas W
• Farouk O
• Fathi A
• Senbel A
• Hamed EE
• Abdelwahab K
• Elzahby IA
• abdallah A
• Abdelaziz M
• Lezoche E

• KMID: 2504430
• DOI: http://doi.org/10.3393/ac.2018.07.19

Abstract

Background
The study aims to assess the functional outcome of anal sphincter sparing procedures (SSP) with TME for anorectal adenocarcinoma.
Methods
In a multicentric, prospective, single-group study in the period between December 2012 and November 2017, 93 patients presented with anorectal adenocarcinoma were included in the study. Sixty-nine patients underwent SSP with TME. SSP included the combined approach of transabdominal TME with intersphincteric resection (ISR) or transanal transabdominal TME (TATA). Using the Per Anal Examination Scoring System (PASS), postoperative anal function was assessed after one year.
Results
Bowel motility time was 50 (±19) hours. The time needed for narcotic analgesia was 54 (±18.8) hours. Mean hospital stay was 15.4 (±10.25) days. Incidence of evident fecal incontinence after ISR is 10.6% (7/67 cases). The Per Anal Examination Scoring System (PASS) findings of 69 cases are as follows: extremely hypotonic 8.6% (6 cases), slightly hypotonic 26.1% (18 cases), normal tone 58% (40 cases), slightly stenotic 3 cases (4.3%), or occluded 2.9% (2 cases). Urinary dysfunction occurred in one case (1.4%). Temporary diversion was performed in 61 patients (87.1%).
Conclusion
Sphincter preservation with TME for anorectal adenocarcinoma helps avoid permanent stoma and provides a reasonable functional outcome. PASS is a new application for postoperative assessment of anal function

Keyword

Postoperative anal continence; Sphincter preservation; Total mesorectal excision; Anorectal adenocarcinoma; Very low rectal cancer