PURPOSE:This study compared oncologic and perioperative outcomes between patients with locally advanced rectal cancer (LARC) treated with beyond total mesorectal excision (bTME) and those with pathologic stage III disease undergoing TME. METHODS:A retrospective analysis was conducted using prospectively collected data from 580 LARC patients treated with curative-intent surgery over a 23-year period. Patients were categorized as those with clinical T4b tumors who underwent bTME with multivisceral resection (MVR) and those with pathologic stage III tumors treated with TME. Demographic, surgical, pathological, and oncologic outcomes were compared. RESULTS:Circumferential resection margin (CRM) positivity was similar between the groups (5.3% vs. 3.6%, P=0.467). Postoperative complications occurred more often in the bTME group (28.9% vs. 16.6%, P=0.004), although major complications were comparable (P=0.812). Five-year local recurrence (10.5% vs. 9.3%, P=0.371), distant metastasis (19.7% vs. 21.4%, P=0.140), disease-free survival (64.4% vs. 66.2%, P=0.326), and overall survival (74.8% vs. 75.5%, P=0.464) demonstrated no significant differences. Within the bTME group, 32 patients (42.1%) underwent major MVR and 44 (57.9%) underwent minor MVR. CRM positivity (6.2% vs. 4.5%, P=0.999), local recurrence (12.5% vs. 9.1%, P=0.714), and distant metastasis (25.0% vs. 15.9%, P=0.388) rates were similar. Five-year disease-free survival (61.5% vs. 72.3%, P=0.454) and overall survival (68.5% vs. 74.8%, P=0.609) favored minor MVR, although the differences were not statistically significant. CONCLUSION:When negative circumferential margins are achieved, margin-driven bTME resections provide long-term oncologic outcomes comparable to standard TME in high-risk rectal cancer, although they are associated with higher overall complication rates.

This study aims to evaluate how advancements in surgical technology and evolving neoadjuvant treatment (NAT) protocols have influenced clinical, pathological, and long-term oncological outcomes in patients with locally advanced distal rectal cancer (LADRC). Particular emphasis is placed on how the evolving practice of a single high-volume colorectal surgeon has mirrored these developments over a 23-year period. This retrospective cohort included 561 patients with LADRC who underwent NAT between 2001 and 2024. Patients were stratified into two groups based on the year 2013, which marked the institutional adoption of robotic surgery, high-resolution 3-Tesla MRI, and the formal implementation of the Watch-and-Wait (W W) strategy: Group I (2001–2012) and Group II (2013–2024). The median follow-up duration was significantly longer in Group 1 (191 ± 2.29 months) compared to Group 2 (71 ± 2.81 months). Local recurrence (LR) occurred in 11.6

This study aimed to assess the outcomes of minimally invasive surgery (MIS) for colon cancer and analyze the impact of tumor localization on survival. A retrospective analysis was conducted on 842 consecutive patients who underwent curative MIS (laparoscopic and robotic) for stage I to III colon adenocarcinoma between 2001 and 2024. The surgical technique adhered to oncological principles, ensuring adequate resection margins and proper lymph node dissection. Patient characteristics, operative data, perioperative outcomes, histopathologic findings, and oncological outcomes were analyzed. The study included 842 patients (59.4% male, 40.6% female) with a median age of 60.3 years. Tumor localization was right colon in 29.5%, transverse colon in 6.5%, and left colon in 64% of cases. In our study, 814 cases (96.7%) were performed using laparoscopic surgery, while 28 cases (3.3%) were performed using robotic surgery. The mean operative time was 135 minutes, with a mean hospital stay of 6 days. Conversion to open surgery occurred in 3% of cases. The mean number of lymph nodes removed was 35 (range: 8 to 72). Pathologic examination revealed that 65% of cases were node-positive stage III. During a mean follow-up of 10 years, local recurrence (LR) was observed in 2.8% of patients, with no significant difference based on tumor localization. Distant metastases (DM) occurred in 12.7% of patients. The 10-year disease-free survival (DFS) rate for all patients was 75%, and the overall survival (OS) rate was 78.7%. The 10-year DFS rates for right colon, transverse colon, and left colon cancers were 74%, 71%, and 76%, respectively. Similarly, the OS rates for the same groups were 78.9%, 75%, and 79%, respectively. Statistical analysis revealed no significant differences in DFS ( P =0.851) or OS ( P =0.789) among the 3 tumor localization groups. Our study demonstrated that MIS is a promising approach for achieving favorable long-term oncological outcomes in colon cancer patients. Consequently, MIS is established as the standard approach in colon cancer surgery. Although right colon tumors are often associated with poorer disease-free and overall survival rates, this study found no significant differences in DFS or OS among left, transverse, and right colon tumors.

Purpose The standard treatment for locally advanced rectal cancer involves neoadjuvant chemoradiation followed by total mesorectal excision surgery. A subset of patients achieves pathologic complete response (pCR), representing the optimal treatment outcome. This study compares the long-term oncological outcomes of patients who achieved pCR with those who attained clinical complete response (cCR) after total neoadjuvant therapy, managed using a watch-and-wait approach. Methods This study retrospectively evaluated patients with mid-low locally advanced rectal cancer who underwent neoadjuvant treatment from January 1, 2005, to May 1, 2023. The pCR and cCR groups were compared based on demographic, clinical, histopathological, and long-term survival outcomes. Results The median follow-up times were 54 months (range, 7–83 months) for the cCR group (n=73), 96 months (range, 7–215 months) for the pCR group (n=63), and 72 months (range, 4–212 months) for the pathological incomplete clinical response (pICR) group (n=627). In the cCR group, 15 patients (20.5%) experienced local regrowth, and 5 (6.8%) developed distant metastasis (DM). The pCR group had no cases of local recurrence, but 3 patients (4.8%) developed DM. Among the pICR patients, 58 (9.2%) experienced local recurrence, and 92 (14.6%) had DM. Five-year disease-free survival rates were 90.0% for cCR, 92.0% for pCR, and 69.5% for pICR (P=0.022). Five-year overall survival rates were 93.1% for cCR, 92.0% for pCR, and 78.1% for pICR. There were no significant differences in outcomes between the cCR and pCR groups (P=0.810); however, the pICR group exhibited poorer outcomes (P=0.002). Conclusion This study shows no significant long-term oncological differences between patients who exhibited cCR and those who experienced pCR.

OBJECTIVE:This study aimed to assess the outcomes of minimally invasive surgery (MIS) for colon cancer and analyze the impact of tumor localization on survival. PATIENTS AND METHODS:A retrospective analysis was conducted on 842 consecutive patients who underwent curative MIS (laparoscopic and robotic) for stage I to III colon adenocarcinoma between 2001 and 2024. The surgical technique adhered to oncological principles, ensuring adequate resection margins and proper lymph node dissection. Patient characteristics, operative data, perioperative outcomes, histopathologic findings, and oncological outcomes were analyzed. RESULTS:The study included 842 patients (59.4% male, 40.6% female) with a median age of 60.3 years. Tumor localization was right colon in 29.5%, transverse colon in 6.5%, and left colon in 64% of cases. In our study, 814 cases (96.7%) were performed using laparoscopic surgery, while 28 cases (3.3%) were performed using robotic surgery. The mean operative time was 135 minutes, with a mean hospital stay of 6 days. Conversion to open surgery occurred in 3% of cases. The mean number of lymph nodes removed was 35 (range: 8 to 72). Pathologic examination revealed that 65% of cases were node-positive stage III. During a mean follow-up of 10 years, local recurrence (LR) was observed in 2.8% of patients, with no significant difference based on tumor localization. Distant metastases (DM) occurred in 12.7% of patients. The 10-year disease-free survival (DFS) rate for all patients was 75%, and the overall survival (OS) rate was 78.7%. The 10-year DFS rates for right colon, transverse colon, and left colon cancers were 74%, 71%, and 76%, respectively. Similarly, the OS rates for the same groups were 78.9%, 75%, and 79%, respectively. Statistical analysis revealed no significant differences in DFS ( P =0.851) or OS ( P =0.789) among the 3 tumor localization groups. CONCLUSION:Our study demonstrated that MIS is a promising approach for achieving favorable long-term oncological outcomes in colon cancer patients. Consequently, MIS is established as the standard approach in colon cancer surgery. Although right colon tumors are often associated with poorer disease-free and overall survival rates, this study found no significant differences in DFS or OS among left, transverse, and right colon tumors.

Although there’s growing information about the long-term oncological effects of robotic surgery for rectal cancer, the procedure is still relatively new. This study aimed to assess the long-term oncological results of total mesorectal excision (TME) performed laparoscopically versus robotically in the setting of rectal cancer. Restrospective analysis of a prospectively maintained database. A total of 489 laparoscopic (L-TME) and 183 robotic total mesorectal excisions (R-TME) were carried out by a single surgeon between 2013 and 2023. The groups were compared in terms of perioperative and long-term oncological outcomes. In the R-TME and L-TME groups, male sex predominated (75.4

The treatment role of Total Mesorectal Excision (TME) in proximal rectal cancers (PRC) is still debated. Partial Mesorectal Excision (PME) can reduce morbidity in PRC patients. The purpose of this study was to compare short-term clinical and long-term oncological outcomes between the two groups. A total of 157 PRC patients were enrolled in this study (114 performed with PME and 43 with TME). The two groups were compared in terms of perioperative and long-term oncological outcomes. The overall postoperative complications rate was higher in TME group (18.4

AIM:Intersphincteric resection (ISR) is an oncologically complex operation for very low-lying rectal cancers. Yet, definition, anatomical description, operative indications and operative approaches to ISR are not standardized. The aim of this study was to standardize the definition of ISR by reaching international consensus from the experts in the field. This standardization will allow meaningful comparison in the literature in the future. METHOD:A modified Delphi approach with three rounds of questionnaire was adopted. A total of 29 international experts from 11 countries were recruited for this study. Six domains with a total of 37 statements were examined, including anatomical definition; definition of intersphincteric dissection, intersphincteric resection (ISR) and ultra-low anterior resection (uLAR); indication for ISR; surgical technique of ISR; specimen description of ISR; and functional outcome assessment protocol. RESULTS:Three rounds of questionnaire were performed (response rate 100%, 89.6%, 89.6%). Agreement (≥80%) reached standardization on 36 statements. CONCLUSION:This study provides an international expert consensus-based definition and standardization of ISR. This is the first study standardizing terminology and definition of deep pelvis/anal canal anatomy from a surgical point of view. Intersphincteric dissection, ISR and uLAR were specifically defined for precise surgical description. Indication for ISR was determined by the rectal tumour's maximal radial infiltration (T stage) below the levator ani. A new surgical definition of T3isp was reached by consensus to define T3 low rectal tumours infiltrating the intersphincteric plane. A practical flowchart for surgical indication for uLAR/ISR/abdominoperineal resection was developed. A standardized ISR surgical technique and functional outcome assessment protocol was defined.

The aim of this study was to compare perioperative and long-term oncological outcomes between laparoscopic sphincter-preserving total mesorectal excision in female patients (F-Lap-TME) and robotic sphincter-preserving total mesorectal excision in male patients (M-Rob-TME) with mid-low rectal cancer (RC). A retrospective analysis of a prospectively maintained database was performed. 170 cases (F-Lap-TME: 60 patients; M-Rob-TME: 110 patients) were performed by a single surgeon (January 2011–January 2020). Clinical characteristics did not differ significantly between the two groups. Operating time was longer in M-Rob-TME than in F-Lap-TME group (185.3 ± 28.4 vs 124.5 ± 35.8 min, p < 0.001). There was no conversion to open surgery in both groups. Quality of mesorectum was complete/near-complete in 58 (96.7%) and 107 (97.3%) patients of F-Lap-TME and M-Rob-TME (p = 0.508), respectively. Circumferential radial margin involvement was observed in 2 (3.3%) and 3 (2.9%) in F-Lap-TME and M-Rob-TME patients (p = 0.210), respectively. Median length of follow-up was 62 (24–108) months in the F-Lap-TME and 64 (24–108) months in the M-Rob-TME group. Five-year overall survival rates were 90.5% in the F-Lap-TME and 89.6% in the M-Rob-TME groups (p = 0.120). Disease-free survival rates in F-Lap-TME and M-Rob-TME groups were 87.5% and 86.5% (p = 0.145), respectively. Local recurrence rates were 5% (n = 3) and 5.5% (n = 6) (p = 0.210), in the F-Lap-TME and M-Rob-TME groups, respectively. The robotic technique can potentially overcome some technical challenges related to the pelvic anatomical difference between sex compared to laparoscopy. Laparoscopic and robotic approach, respectively in female and male patients provide similar surgical specimen quality, perioperative outcomes, and long-term oncological results.

This study aimed to compare perioperative, long-term oncological, and anorectal functional outcomes of robotic total mesorectal excision (R-TME) and laparoscopic total mesorectal excision (L-TME) sphincter-saving total mesorectal excision in female patients with rectal cancer. Retrospective analysis of prospectively maintained database was performed. Sixty-eight cases (L-TME, n = 34; R-TME, n = 34) were performed by a single surgeon (January 2014–January 2019). Patient characteristics, perioperative recovery, postoperative complications, pathology results, and oncological outcomes were compared between the two groups. Clinical characteristics did not differ between the groups. Mean operating time was longer in R-TME (165.50 ± 95.50 vs. 124.50 ± 82.60 min, p < 0.001). There was no conversion to open surgery in both groups. Mesorectal integrity was complete in both groups (100

Abstract Background The role of preoperative chemoradiotherapy (CRT) in the management of proximal rectal cancer (PRC) is still debated. The purpose of this study was to compare perioperative and long-term oncological outcomes between PRC patients undergoing CRT + surgery and upfront surgery. Methods A total of 157 patients were retrospectively included in this study (131 treated with upfront surgery and 26 with CRT). CRT and upfront surgery groups were compared in terms of perioperative and long-term oncological outcomes. Results CRT group of patients was associated with higher rate of overall postoperative complications (42.3% vs. 18.3%, p < 0.05) and class III-IV complications (15.4% vs. 8.4%, p < 0.05). The 3 and 5-years overall survival (OS) rates for upfront surgery and CRT group were: 96.1%, 91.5% and 95.8%, 71.7% (p < 0.05), respectively. The 3 and 5-years disease-free survival (DFS) rates for upfront surgery and CRT were: 92.4%, 86.8% and 90.6%, 68.6% (p < 0.05), respectively. Conclusion The omission of CRT in patients with PRC did not impair the perioperative and long-term oncological outcomes. CRT is associated to higher complications rates and severity and to worst OS and DFS.

Abstract Aim: To reveal whether chemoradiotherapy-consolidation chemotherapy (CRT-CNCT) treatment provides more organ preservation in locally advanced rectal cancer (LARC) and its effect on oncological outcomes. Method: Retrospective analysis of prospectively maintained database was performed. Oncological outcomes of mid-low LARC patients (n=60) were analyzed after a follow-up of 63 (50-83) months. Patients with clinical complete response (cCR) were treated with the watch-and-wait (WW) protocol. Patients who could not achieve cCR were treated with total mesorectal excision (TME) or local excision (LE). Results: Thirty-nine (65%) patients who achieved cCR were treated with the WW protocol. TME was performed in 15 (25%) patients and LE was performed in 6 (10%) patients. During the follow-up period, 10 (25.6%) patients in the WW group had regrowth (RG) and 3 (7.6%) had distant metastasis (DM). 5-year overall survival (OS) and disease-free survival (DFS) were 90.1% and 71.6%, respectively, in WW group. 5-y OS and DFS were 94.9% (95% CI: 88-100%) and 80% (95% CI: 55.2-100%), respectively, in the RG group. 5-y OS and DFS were 90.1% (95% CI: 78.9-100%) and 96.6% (95% CI: 89.9-100%) in the non-RG group. 5-y OS and DFS were 78% (95% CI: 55.8-100%) and 60% (95% CI: 35.2-84.8%) in TME group. Conclusion: CRT-CNCT ​​provides cCR as high as 2/3 of LARC patients. While the WW protocol provides organ preservation, RGs developed during follow-up can be successfully salvaged without causing oncological disadvantage.

Aim of this study was to compare operative, long-term oncological and functional outcomes of laparoscopic (LISR) and robotic (RISR) intersphincteric resection in low-lying rectal cancer. Retrospective analysis of prospectively maintained database was performed. 115 cases (LISR, n = 55; RISR, n = 60) were performed by a single surgeon (January 2011–January 2020). Clinical characteristics did not differ between the groups. Operating time was longer in RISR (160.0 ± 45.7 vs. 205.0 ± 36.5 min, p = 0.035). There was no conversion in RISR, whereas in LISR, two patients (3.6

BACKGROUND:The objective of this study was to determine how long to wait in locally advanced rectal tumor (LARC) patients who receive total neoadjuvant therapy (TNT) and achieve a clinical complete response (cCR), and to identify the clinical parameters that affect the waiting period for the watch-and-wait strategy (W &W).MATERIALS AND METHODS:The data of patients who achieved cCR between February 2015 and June 2020 were examined retrospectively. The week in which patients with cCR at the end of TNT achieved clearance was determined by reanalyzing recorded endoscopy video images. In the assessment at the time of the initial diagnosis, tumor characteristics, such as digital rectal examination findings, MRI stage, location with respect to the puborectalis muscle, annularity, and tumor size, were recorded prospectively.RESULTS:A total of 54 patients were included in this study. According to the MRI-T stage, 14 cases were cT3a, 22 were cT3b, and 18 were cT3c-T4. Forty-four percent of the cases achieved cCR at 8-10 weeks, 19% at 12-16 weeks, 20% at 16-22 weeks, and 17% at 20-26 weeks. Patients with tumors that were early MRI-T stage (cT3a), negative clinical circumferential resection margin, mobile, small (≤4 cm), located above the puborectalis muscle and showed <180 degrees annularity achieved cCR significantly earlier than those with other tumors (p<0.05).CONCLUSION:In this study, cCR was achieved in less than half (44%) of the cases during the 8-10 week waiting period. In the W&W strategy, the initial assessment for cCR seems insufficient, and we may need to wait up to 26-30 weeks, especially in patients with advanced-stage tumors.

Aim To report long-term oncological outcomes and organ preservation rate with a chemoradiotherapy-consolidation chemotherapy (CRT-CNCT) treatment for locally advanced rectal cancer (LARC). Method Retrospective analysis of prospectively maintained database was performed. Oncological outcomes of mid-low LARC patients (n=60) were analyzed after a follow-up of 63 (50-83) months. Patients with clinical complete response (cCR) were treated with the watch-and-wait (WW) protocol. Patients who could not achieve cCR were treated with total mesorectal excision (TME) or local excision (LE). Results Thirty-nine (65%) patients who achieved cCR were treated with the WW protocol. TME was performed in 15 (25%) patients and LE was performed in 6 (10%) patients. During the follow-up period, 10 (25.6%) patients in the WW group had regrowth (RG) and 3 (7.7%) had distant metastasis (DM). Five-year overall survival (OS) and disease-free survival (DFS) were 90.1% and 71.6%, respectively, in the WW group. Five-year OS and DFS were 94.9% (95% CI: 88-100%) and 80% (95% CI: 55.2-100%), respectively, in the RG group. For all patients (n=60), 5-year TME-free DFS was 57.3% (95% CI: 44.3-70.2%) and organ preservation-adapted DFS was 77.5% (95% CI: 66.4-88.4%). For the WW group (n=39), 5-year TME-free DFS was 77.5% (95% CI: 63.2-91.8%) and organ preservation-adapted DFS was 85.0% (95% CI: 72.3-97.8%). Conclusion CRT-CNCT provides cCR as high as 2/3 of LARC patients. Regrowths, developed during follow-up, can be successfully salvaged without causing oncological disadvantage if strict surveillance is performed.

Abstract Aim To reveal whether chemoradiotherapy-consolidation chemotherapy (CRT-CNCT) treatment provides more organ preservation in locally advanced rectal cancer (LARC) and its effect on oncological outcomes. Method Retrospective analysis of prospectively maintained database was performed. Oncological outcomes of mid-low LARC patients (n = 60) were analyzed after a follow-up of 63 (50–83) months. Patients with clinical complete response (cCR) were treated with the watch-and-wait (WW) protocol. Patients who could not achieve cCR were treated with total mesorectal excision (TME) or local excision (LE). Results Thirty-nine (65%) patients who achieved cCR were treated with the WW protocol. TME was performed in 15 (25%) patients and LE was performed in 6 (10%) patients. During the follow-up period, 10 (25.6%) patients in the WW group had regrowth (RG) and 3 (7.6%) had distant metastasis (DM). 5-year overall survival (OS) and disease-free survival (DFS) were 90.1% and 71.6%, respectively, in WW group. 5-y OS and DFS were 94.9% (95% CI: 88–100%) and 80% (95% CI: 55.2–100%), respectively, in the RG group. 5-y OS and DFS were 90.1% (95% CI: 78.9–100%) and 96.6% (95% CI: 89.9–100%) in the non-RG group. 5-y OS and DFS were 78% (95% CI: 55.8–100%) and 60% (95% CI: 35.2–84.8%) in TME group. Conclusion CRT-CNCT provides cCR as high as 2/3 of LARC patients. While the WW protocol provides organ preservation, RGs developed during follow-up can be successfully salvaged without causing oncological disadvantage.

The aim of this study was to determine the superiority between the robotic da Vinci Si® (Si group) and da Vinci Xi® (Xi group) generation in patients with mid-low rectal cancer. Between December 2011 and December 2017, 88 patients with mid-low rectal cancer were operated on using the Si robotic system, from January 2018 to May 2021, 62 more patients with mid-low rectal cancer were operated on using the Xi robotic system. Perioperative and postoperative short-term outcomes were compared between the two groups. Univariate and multivariate Cox-regression analysis were performed to determine factors affecting operating time. A cumulative sum (CUSUM) analysis was also performed to determine the learning curve of the primary surgeon. All patients underwent sphincter saving total mesorectal excision (TME). The overall operating time was significantly shorter in the Xi group (181.3 ± 31.8 min in Si group vs 123.6 ± 25.7 min in the Xi group, p < 0.001). There were no significant differences in terms of conversion rates, mean hospital stays, complications and histopathologic data. CUSUM analysis show completion of learning curve in 44th case of Si group. Univariate and multivariate analysis demonstrated that the learning curve of the primary surgeon (p < 0.001) and the type of robotic system (Xi) are only two factors associated with operating time (OR, 95% CI p; 3.656, 0.665–9.339, p < 0.001). Our study found that the robotic da Vinci Xi systems provide significantly shorter operating time comparing with Si systems, when performing sphincter-preserving TME in mid-low rectal cancer patients. Surgical system (da Vinci Xi) and primary surgeon learning curve are two independent risk factors which associated shortened operating time. Postoperative complication rates and histopathologic outcomes are similar in both groups.

Acute rectal ischemia is a rare entity because the rectum has abundant blood supply from the inferior mesenteric, internal iliac, internal pudendal, and marginal artery with rich collaterals. We present a case of an acute ischemic proctosigmoiditis with a history of rectal cancer who completely recovered after total neoadjuvant treatment and was in the “watch-and-wait” protocol. Urgent laparoscopic low anterior resection and protective ileostomy were performed. Causes of acute rectosigmoid ischemia include old age, diabetes, atherosclerosis, previous aortic surgery due to aneurysm, vasculitis, and radiotherapy. Ischemia may be present as only involving the mucosa, which can be managed conservatively, but full-thickness necrosis requires urgent surgical intervention. Endoscopic examination is the gold standard in initial diagnosis. Ischemic gangrene of the rectosigmoid colon is a rare condition and can be life-threatening unless an urgent surgical intervention is performed.

INTRODUCTION:The development of new surgical techniques and devices, as well as the improvements in neoadjuvant chemoradiotherapy enabled intersphincteric resection (ISR), has reduced permanent colostomy usage. The aim of this study was to assess the long-term oncological and functional outcomes of patients who underwent partial ISR for rectal cancer located less than 5cm from the anal verge.MATERIALS AND METHODS:A series of 106 consecutive patients with very low rectal cancer underwent curative partial ISR from January 2006 to September 2019 were retrospectively evaluated. One-hundred-three (97%) of 106 patients received neoadjuvant chemo-radiotherapy. Overall survival (OS), disease-free survival (DFS), and local recurrence (LR) rates were calculated using Kaplan-Meier methods. The Wexner incontinence score and Kirwan classification were used to evaluate patients' functional results.RESULTS:The median follow up was 60 months (range, 18-174). The estimated five-year overall and disease-free survival rates were 89% and 81.6%, respectively. Five-year local recurrence and distant metastasis rates were 6.6% and 10.4%, respectively. There was no in-hospital and 30-day mortality. The median Wexner score was 9 (range, 0-20) for 72 patients. Age (<65 years, p=0.027) and gender (male, p=0.019) had a positive effect on functional outcomes after surgery. One and five years colostomy-free survival rates were 96% and 89%, respectively.CONCLUSION:Intersphincteric resection techniques are feasible for patients with very low rectal cancer, providing good oncological and functional outcomes.