Is pull-through an acceptable replacement for low anterior resection for rectal cancers in low-income setting? A case-control study.
Background
Colorectal cancers are the second most common cancers overall and are the third deadliest cancers. Complete resection is the treatment of choice for rectal cancers and chemoradiotherapy (CRT) is strongly recommended in stage 2 and 3. Low anterior resection (LAR) is the most common procedure used, but it requires the use of stapler which might be very expensive as one study estimated the median cost of LAR inpatients to be over 13.000 USD. However, coloanal pull-through (PT) used to be the common procedure before introducing staplers in the twentieth century and can be less expensive, but with higher complication rates.


Materials and methods
This is a retrospective case-control study from patients' records who underwent either LAR or PT for their rectal cancer in Syria. All patients had either stage 2 or 3 cancer and were treated by the same group of surgeons and received the same adjuvant and neoadjuvant CRT protocol. Patients from both groups had the same prognosis and stages.


Results
This study included 60 participants, of which, 30 had LAR and 30 had PT. They all had successful removal of the cancer and follow-ups were for 1 year after the surgery. There were no significant differences between the two procedures in post-operative leak, urinary retention, stricture, sexual function and recurrence (p > 0.05). However, post-operative incontinence was more frequent with PT (p = 0.027).


Conclusion
PT can be an acceptable substitute of LAR in low income settings despite having higher incidence of incontinence.
['Ghareeb|Amjad|A|', 'Kakaje|Ameer|A|', 'Ghareeb|Ayham|A|', 'Alahmar|Fadi Obaid|FO|']
Pull-through Low anterior resection Rectal cancer Low-income Stapler APR, Abdominal perineal resection CRT, Chemoradiotherapy FU, Fluorouracil LAR, Low anterior resection PT, Pull-through SPSS, Statistical Package for the Social Sciences STROCSS, Strengthening the reporting of cohort studies in surgery TME, Total mesorectal excision Trans-anal