Surgeons frequently remove both the rectum and the anus from patients who have colorectal cancer in the lower portion of the colon. The patient usually requires a permanent colostomy if the anus is removed; permanent colostomy is an opening from  which faeces is collected in a bag that is fastened to the abdominal wall. Surgery that “spares” the anal sphincter while safely removing the rectal cancer is known as sphincter-sparing surgery.

The rectum can be completely or partially removed during Low Anterior Resection, a surgical option for low rectal cancer. Rectal cancer treatment frequently necessitates the removal of entire rectum.

The final component of digestive system is the large intestine, which is composed of colon and rectum. The rectum and anal region make up the final 18 cm of the large intestine. Sphincters are located along the anal canal, which is the 3.8 cm portion lying next to the anal opening. Principles of cancer surgery includes removing a minimum of 2 cm of rectum below the edge of the cancer to ensure complete removal of rectal cancer.

Advantages of Sphincter-sparing Surgery

This surgery allows a patient with low rectal cancer retain control over the bowel movements; it also helps to

• Enhances the quality of life
• Provides cancer cure rates equal to more extreme surgery
• Eliminates the need to remove the sphincter muscles and anus, which allows you to eventually return to passing bowel movements through your anus

What Happens During Sphincter-sparing Surgery?

In this surgery, the surgeon mobilizes the rectum beyond the tumour till the edge of the sphincter. He tries to get beyond the tumour by a minimum of 2 cm and creates a space to place the stapler. If possible, it is called sphincter sparing surgery and prevents the patient from having a permanent stoma.

What are these surgeries called

• These surgeries are called Low Anterior Resection or
• Ultra Low Anterior Resection

What are the special requirement for sphincter saving surgery?

There are many requirements for this surgery. The most important is availability of stapling devices. As we know that pelvis is a very small narrow area located in the lower part of the abdominal cavity. The rectum is located in the pelvis. Along with rectum, the pelvis also has a urinary bladder as well prostate in males and uterus and both ovaries in females.

Once the rectum is removed, precise stapling instruments help the surgeon to join back the cut end of the lower rectum as well as the cut end of the left colon. The include circular stapling devices as well as flexible right angles stapling devices. There are many variants available to choose from. The choice will depend upon the kind of surgery as well as the patients’ habitat.

What are the precautions required for sphincter saving surgeries?

Oncologic principles of cancer removal have to be followed.

Can sphincter saving surgeries be done with minimal access?

Yes. These surgeries can be done with a robotic or laparoscopic approach. However, a small incision will have to be given to remove the excised part of colon.

Conclusion

Thus, if one has a low rectal cancer, there is a probability that sphincter saving procedure can be done. Patient should consult a colorectal surgeon and discuss the possibility.