Risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery

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 sphincterunpreserved 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.