Two vs. Three-Stage Abdominoperineal Resection in Rectal Cancer: A Surgical Strategy Debate

Background: Although Abdominoperineal Resection (APR) rates have declined over the last fifty years, it remains the best treatment option in many circumstances. Objectives: This study aimed to investigate the short-term outcomes of two-stage versus three-stage laparoscopic abdominoperineal resection in rectal cancer. Methods: This retrospective cohort study included ۱۱۳ patients with rectal cancer eligible for laparoscopic APR at Razavi Hospital in Mashhad from ۲۰۲۰ to ۲۰۲۳. Inclusion criteria were age over ۱۸ and a confirmed diagnosis via pathology, while exclusion criteria included recurrent rectal cancer, anal canal, and rectosigmoidal tumors, tumors located more than ۱۵ centimeters from the anal verge, and concurrent colonic lesions. Data analysis was conducted using R software and SPSS. Results: The study included ۴۲ patients undergoing a two-step surgical technique and ۷۱ patients with a three-step technique. Results showed that the two-step group had a longer mean hospital stay (۹.۴۸ ± ۴.۰۹ days) than the three-step group (۷.۶۳ ± ۱.۳۰ days; p = ۰.۰۰۲). Surgical site infections occurred in ۱۵.۶% of the two-step patients, whereas none occurred in the three-step group (p=۰.۰۲۰). The mean surgery duration was also longer in the two-step group (۲۲۲.۱۸±۵۶.۰۸ minutes) than in the three-step group (۱۷۰.۷۸±۲۹.۱۳ minutes; p=۰.۰۰). Revision surgery was required in ۲۳.۸% of the two-stage group, compared with ۴.۲% in the three-stage group (p=۰.۰۰۲). Blood transfusion rates were similar: ۲۳.۸% in the two-step group and ۲۲.۵% in the three-step group (p=۰.۸۷۶). Conclusion: The three-stage approach to APR may improve surgical outcomes. However, larger prospective studies are needed to confirm these findings.

کلیدواژه ها:

Abdominoperineal Resection ، Rectal Cancer ، Outcomes ، Surgical Approach