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Table 2 Summary of the current trends in surgical procedures for low rectal cancers

From: An anatomic anal sphincter-saving procedure for rectal cancers located at anorectal junction

Operation Technical description Indication Disadvantages Reference
Abdomino perineal resection (APR) Sigmoid, rectum, and anus are excised sparing the levator ani muscles complex (hourglass-like specimen) Lesions at the lower third of the rectum Poor oncologic outcome, permanent colostomy Hussain et al. [8]
Extralevator abdomino-perineal excision (ELAPE) APR + excision of the levator ani muscles complex (cylindrical specimen) Lesions at the lower third of the rectum Permanent colostomy Carpelan et al. [17]
Intersphicteric resection (ISR) Surgical plane in the intersphicteric space, dissection of the internal anal sphincter, saving the external sphincter • Lesions at the lower third of the rectum that do not involve the levator ani muscles
• Good pre-operative sphincter function and continence
May not be suitable for patients that have undergone neoadjuvant treatment Schiessel et al. [4]
Subtotal intersphincteric resection/partial external sphincteric resection ISR + partial external anal sphincter resection • Lesions of the lower third of the rectum invading part of the external anal sphincter
• Good pre-operative sphincter function and continence
Not applicable for lesions invading the levator ani muscle Mukai et al. [10]
Hemilevator excision (HLE) Resection of the levator ani muscle, the deep part of external anal sphincter and the internal sphincter ipsilaterally. The contralateral ones are preserved • Lesions at the lower third of the rectum involving the levator ani muscle in one side
• Good pre-operative sphincter function and continence
Not applicable for cancers circumferentially infiltrating levator ani complex Noh et al. [11]