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Funahashi et al. Mini-invasive Surg 2018;2:27 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2018.28

Original Article Open Access

Clinical feasibility of sphincter-preserving resection
with transanal rectal dissection for low-lying rectal
cancer in Japanese patients: a single-center cohort
study

Kimihiko Funahashi , Junichi Koike , Hiroyuki Shiokawa , Mitsunori Ushigome , Tomoaki Kaneko ,
1
1
1
1
1
Satoru Kagami , Takamaru Koda , Tatsuo Teramoto 2
1
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1 Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo 143-8541, Japan.
2 Department of Surgery, Jyujyo Hospital, Chiba 292-0003, Japan.
Correspondence to: Dr. Kimihiko Funahashi, Department of General and Gastroenterological Surgery, Toho University Omori
Medical Center, 6-11-1 Omorinishi, Ota-ku, Tokyo 143-8541, Japan. E-mail: kingkong@med.toho-u.ac.jp
How to cite this article: Funahashi K, Koike J, Shiokawa H, Ushigome M, Kaneko T, Kagami S, Koda T, Teramoto T. Clinical
feasibility of sphincter-preserving resection with transanal rectal dissection for low-lying rectal cancer in Japanese patients: a
single-center cohort study. Mini-invasive Surg 2018;2:27. http://dx.doi.org/10.20517/2574-1225.2018.28
Received: 27 May 2018 First Decision: 1 Aug 2018 Revised: 2 Aug 2018 Accepted: 2 Aug 2018 Published: 28 Aug 2018

Science Editor: Gordon N. Buchanan Copy Editor: Jun-Yao Li Production Editor: Huan-Liang Wu

Abstract
Aim: Recently, the transanal down-to-up rectal dissection, a new approach to improve the difficult total mesorectal
excision (TME) for low-lying rectal cancer, has been popularized. This study assessed the long-term oncologic and
functional outcomes after sphincter-preserving resection combined with transanal rectal dissection (TARD) under direct
vision for both complete TME and preservation of the internal anal sphincter (IAS) as much as possible to clarify the
clinical feasibility of this approach.

Methods: A prospective cohort study was conducted in 90 Japanese patients between April 2003 and March 2012.

Results: Abdominoperineal resection (APR) was needed in 17 patients (18.9%) including 14 salvage APRs. Local
recurrences occurred in 5 sphincter-preserving resection patients (6.8%). No significant between-group differences
were observed in overall survival or 5-year disease-free survival. A significant benefit of preserving the internal anal
sphincter completely in sphincter-preserving resection was found on the Wexner incontinence score (P = 0.005), low
anterior resection syndrome score (P = 0.002), and visual analogue scale (P = 0.047).

Conclusion: TARD, performed under direct vision for both complete TME and preservation of the IAS as much as
possible in sphincter-preserving resections for low-lying rectal cancers in Japanese patients, does not negatively impact
oncologic outcomes and could have the benefit of minimizing postoperative anorectal dysfunction by preserving the
internal anal sphincter.

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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