Onkologische Ergebnisse nach schließmuskelerhaltender vs. schließmuskelentfernender Rektumchirurgie

Oncological studies show better long-term results after sphincter-preserving operative procedures. The traumatic abdomino perineal resection (APR) results in many complications and appears to have a negative effect on the oncological long-term course.

Meta-analyses and register-based large long-term studies were analyzed. The essential oncological endpoints, such as local recurrency rate, tumor-free survival and overall survival are presented.

In comparison to the APR-group the sphincter preservation group showed a significantly more favorable 5‑year survival rate (pooled odds ratio, OR, 1.73, p = 0.0002), a significantly lower local recurrency rate (OR 0.63), p < 0.00001 and a significantly lower risk of a positive circumferential resection margin (OR 0.43, p < 0.00001). The complication rate is lower in the sphincter-preserving operative modality.

The supposed more radical rectal extirpation with removal of the sphincter does not lead to an oncological advantage for the patient and should be avoided in favor of sphincter-preserving procedures. Minimally invasive surgical procedures protect the perioperative immunocompetence and explain the advantageous oncological results. Transanal total mesorectal excision (TaTME) is currently the optimal surgical procedure for very deep and intersphincteric rectal resection and reduces the extirpation rates to a minimum.