Sphincter-Sparing Rectal Surgery
What is sphincter-sparing surgery?
Sphincter-sparing surgery for rectal cancer involves removal of the rectum with connection of the colon to the anus thereby preserving the anal sphincters and continence.
How is sphincter-sparing surgery different than traditional rectal cancer surgery?
Traditionally, surgery for low rectal cancers has been abdominoperineal resection (APR), which involves removal of the entire rectum and anus, leaving the patient with a permanent colostomy. This is due to the anatomical challenges of surgery in the low pelvis and proximity of low rectal tumors to the anal sphincters. However, with focused training and experience performing pelvic surgery colorectal surgeons are now able to offer sphincter-sparing rectal cancer surgery for many cancers of the mid and low rectum.
The standard of care for rectal cancer surgery is total mesorectal excision (TME), which involves removal of the rectum with it’s entire envelope of lymph node tissue. TME together with neoadjuvant chemoradiation (radiation and chemotherapy given before surgery) has significantly reduced the risk of rectal cancer recurrence and improved survival. Radiation and chemotherapy is given before surgery to shrink large tumors making it more likely for the surgeon to get a negative resection margin on the tumor.
When the cancer is very close but not involving the anal sphincters a coloanal anastomosis may be performed where the rectum is removed and the colon is sewn to the anus. A temporary ileostomy is performed at the same time to allow the connection point to heal. Once healed and recovered from surgery and any additional chemotherapy, the ileostomy may be reversed. Unlike an APR that involves a permanent colostomy, coloanal anastomosis preserves continence.
Sphincter-sparing rectal cancer surgery can be performed with minimally invasive techniques including laparoscopy and robotic-assisted surgery. In some cases, traditional open surgery is necessary depending on an individual’s overall health and the nature of the tumor. Dr. Zaghiyan is skilled in performing complex rectal cancer surgery and strives to offer every patient a safe cancer operation while striving for sphincter preservation. Make an appointment with Dr. Zaghiyan for a private consultation in her office in Los Angeles to discuss your particular situation and obtain her expert opinion.