Transsphincteric rectal resection techniques should be considered as sphincter-sparing surgical procedures in lower rectal cancer cases with external sphincteric invasion because the invased proximal sphincteric segment can be resected

Purpose: Tumor invasion of the external anal sphincteric muscle in patients with lower rectal cancer is one of the most important contraindications for the intersphincteric resection technique, which is the most common sphincter-sparing method in lower rectal cancer surgery. The main purpose of this article is showed that in lower rectum patients with external anal sphincter invasion, the tumoral lower rectal segment can be excised together with the invaded proximal segment of the external anal sphincter muscle system using the transsphincteric rectal resection surgeries performed with combined abdominal and perineal access, and it is highlighted that they can be considered as sphincter-sparing surgical procedures in these cases. Methods: : This study includes the retrospective evaluation of 4 male and 1 female patient with advanced lower rectal adenocarcinoma detected external anal sphincteric invasion on their preoperative MRI results who underwent proximal segmental sphincteric excision and sphincter-sparing rectal resection operations in transsphincteric plan after neoadjuvant chemoradiotherapy. Results: : In the postoperative follow-up of patients; Perineal fistula developed in 3 patients. Anastomotic stenosis developed in 2 patients, one of whom developed a perineal fistula. No external sphincteric invasion was detected in the postoperative histopathological evaluation of 1 patient. In the anal sphincteric pressure measurements made in the postoperative period, partial decreases were observed in the resting and maximal squeezing anal pressures of the patients. In the clinical follow-up of the patients whose ileostomy was closed, it was determined that sufficient continence was achieved. One patient died at postoperative 8th month following systemic metastases occurring at postoperative 5th month. Conclusion: Invased proximal sphincteric segment can be resected by using transsphinteric rectal resection techniques in advanced lower rectal cancer cases.