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Preserving the Anus in Ultra-Low Rectal Cancer May Improve Survival and Quality of Life

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Preserving the Anus in Ultra-Low Rectal Cancer May Improve Survival and Quality of Life

Patients with ultra-low rectal cancer (ULRC)—tumors within 5 cm of the anus—face a tough decision. Surgery must remove all cancer while balancing quality of life. The standard approach, abdominoperineal resection (APR), removes the anus and requires a permanent stoma bag. Another option, intersphincteric resection (ISR), can preserve the anus and avoid a permanent stoma, but doctors have debated whether it is equally safe.

A new study from China reviewed 803 patients treated between 2012 and 2023. Half underwent ISR and half underwent APR. Researchers followed patients for nearly 4 years to compare outcomes.

Key findings:
– Survival was better with ISR: 5-year overall survival was 81% with ISR vs. 74% with APR.
– Recurrence was lower with ISR: Local recurrence happened in 9.5% with ISR vs. 12.9% with APR.
– Fewer complications overall: Although ISR had a higher rate of anastomotic leaks (11% vs. 1%), patients had fewer total complications (29% vs. 42%) and shorter hospital stays (10 vs. 13 days).
– APR patients experienced more incision infections and urinary problems.

This study suggests that for many patients, ISR may be a safe alternative to APR, offering not only preserved anal function and improved quality of life but also better long-term survival.

Patients should discuss with their surgical team whether ISR is an option, as the best approach depends on the tumor’s location, size, and spread.

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