Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2025; 17(3): 101061
Published online Mar 27, 2025. doi: 10.4240/wjgs.v17.i3.101061
Risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery
Jia-Rui Liu, Jin Zhang, Xiang-Long Duan
Jia-Rui Liu, Xiang-Long Duan, The Second Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China
Jia-Rui Liu, Health Science Center, Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
Jin Zhang, Department of Clinical Nutrition, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China
Xiang-Long Duan, Institute of Medical Research, Northwestern Polytechnical University, Xi'an 710072, Shaanxi Province, China
Xiang-Long Duan, Second Department of General Surgery, Third Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710068, Shaanxi Province, China
Author contributions: Liu JR and Duan XL designed the research study; Liu JR, Zhang J, and Duan XL conducted the research; Liu JR and Duan XL participated in the investigation and contributed to the methodological framework; Duan XL directed the research; Zhang J contributed to the visualization of this study; Liu JR and Duan XL performed data analysis and drafted the manuscript; All authors reviewed and approved the final version of the manuscript.
Supported by The National Natural Science Foundation of China, No. 82460107; and Science and Technology Talent Support Program of Shaanxi Provincial People's Hospital, No. 2021 LJ-05.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Shaanxi Provincial People's Hospital, No. 2022-R026.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiang-Long Duan, The Second Department of General Surgery, Shaanxi Provincial People's Hospital, No. 256 Youyi Road West, Xi'an 710068, Shaanxi Province, China. duanxianglong@nwpu.edu.cn
Received: September 4, 2024
Revised: November 28, 2024
Accepted: January 13, 2025
Published online: March 27, 2025
Processing time: 172 Days and 19.5 Hours
Abstract
BACKGROUND

The surgical management of rectal cancer is continuously advancing, with a current emphasis on minimising the need for a permanent stoma. Understanding the risk factors influencing sphincter preservation is crucial for guiding clinical decision-making and optimising preoperative patient evaluation.

AIM

To examine the risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery.

METHODS

A retrospective analysis of the demographics, preoperative and intraoperative data, and pathological findings of 179 patients with rectal cancer who underwent laparoscopic radical rectal cancer surgery at our hospital between January 2022 and December 2023 was conducted. These clinical data were compared between two groups: Patients with sphincter preservation and those without, categorised as the sphincter-preserved and sphincter-unpreserved groups, respectively.

RESULTS

Of the 179 patients analysed, 150 were in the sphincter-preserved group and 29 were in the sphincter-unpreserved group. Tumour height was significantly greater in the sphincter-preserved group compared to the sphincter-unpreserved group. Conversely, elevated levels of carcinoembryonic antigen, carbohydrate antigen 19-9, and plasma D-dimer were significantly higher in the sphincter-unpreserved group. Significant differences were also observed between the two groups in terms of place of residence, presence of colonic polyps, neoadjuvant chemotherapy, preoperative radiotherapy, mucinous adenocarcinoma, nerve invasion, and tumour height. No significant differences were observed for other parameters. Logistic regression analysis identified colonic polyps, mucinous adenocarcinoma, nerve invasion, and tumour height as independent risk factors for sphincter preservation.

CONCLUSION

Several risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery were identified. These factors could be valuable tools for guiding clinical decision-making and optimising preoperative patient evaluations.

Keywords: Rectal cancer; Laparoscopic surgery; Sphincter preservation; Risk factors; Preoperative evaluation

Core Tip: This study aimed to identify key risk factors associated with achieving tumour resection and sphincter preservation in patients with rectal cancer by analysing clinical data from 179 patients who underwent laparoscopic radical rectal cancer surgery. Patients with nerve invasion, mucinous adenocarcinoma, and tumours in the lower to middle rectum were at higher risk of sphincter non-preservation. Logistic regression analysis identified nerve invasion, mucinous adenocarcinoma, and tumour height as independent risk factors for sphincter preservation. Conversely, sphincter preservation rates were higher among patients with concomitant colonic polyps. These findings provide valuable insights for identifying high-risk patients and guiding targeted interventions and preoperative evaluations.