Comparative study of functional outcomes between ultra‐low anterior resection and inter‐sphincteric resection: a propensity matched analysis

Background Comparative bowel functional outcomes between ultralow anterior resections (ULAR) and inter‐sphincteric resection (ISR) for similar tumour and patient characteristics is not known. Methods Single centre study of low rectal caners (11) was found in 5.6% versus 33% after ULAR and ISR, respectively. Major LARS (score > 29) was demonstrated in 11% versus 25% in ULAR versus ISR (p = 0.293). Majority in both groups has no LARS (score < 20), that is, 72.2% versus 63.9% in ULAR against ISR. Besides these, stool fragmentation (p < 0.001), nocturnal defecation (p < 0.001) and use of anti‐diarrhoeal medications (p = 0.023) were significantly more after ISR. Conclusions Bowel continence was relatively inferior after ISR as compared to an ULAR for low rectal cancers in matched cohorts. Major LARS in ISR was twice as prevalent without statistical differences. Functional comparisons between trans‐abdominal inter‐sphincteric dissection with stapled colo‐anal anastomosis and conventional perineal inter‐sphincteric resection with hand‐sewn anastomosis has not been previously performed for low rectal cancers. In this propensity matched analysis, bowel continence (Wexner scores) was superior for trans‐abdominal inter‐sphincteric dissection without significant difference in the low anterior resection syndrome score.