A novel sphincter-preserving technique for radical resection of low rectal cancer with sacral invasion

Background For patients with tumors involving the presacral fascia and abutting or invading the sacrum, Pelvic exenteration with en bloc sacrectomy is necessary. However, the resection of multiple pelvic organs significantly impairs the patient's quality of life. Method We introduce a new technology here: for rectal cancer involving the sacrum (at or below S3) or the presacral fascia, we proposed that en bloc tumor resection with colorectal anastomosis is a feasible strategy in patients with tumor-free anal sphincters and at least unilateral single S3 nerve root. Results No one experienced complications above Clavien-Dindo IIIa during the median follow-up period of 8.5 months (range: 4–17 months). Follow-up anorectal manometry at 3 months post-surgery revealed preserved anal sphincter contractile function of all patients, which led to ileostomy reversal procedure. Conclusion The sphincter-preserving technique for the radical resection of low rectal cancer with sacral or presacral fascia invasion is feasible.