Review of sphincter-preserving techniques for ultra-low rectal cancer

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Frontiers in Medicine Published May 11, 2026 Medically reviewed May 11, 2026 DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider that sphincter preservation in ultra-low rectal cancer involves trade-offs between oncological safety and functional outcomes.

This is a narrative review that synthesizes evidence on six sphincter-preserving surgical techniques for patients with ultra-low rectal cancer. The techniques include local excision, low anterior resection with or without prophylactic ileostomy or ileal stent, intersphincteric resection, modified Bacon and Parks procedures, transanal total mesorectal excision, and Natural Orifice Specimen Extraction Surgery with Precision Functional Sphincter-Preserving Surgery.

The authors report that oncological outcomes are satisfactory across these techniques. However, postoperative anal function is identified as a major concern. Preliminary evidence suggests that NOSES-PPS may offer benefits in preserving anal function, but this finding is based on limited data.

Key limitations noted by the authors include small sample sizes and a lack of large-scale trials. The review does not report specific effect sizes, absolute numbers, p-values, or confidence intervals for the synthesized outcomes.

Practice relevance is restrained; optimal outcomes depend on patient selection, surgical expertise, and perioperative management. The evidence is preliminary, and conclusions should be interpreted with caution due to the noted limitations.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

Ultra-low rectal cancer refers to a tumor situated very close to the anal verge, typically within 3 cm from the proximal end of the anal dentate line. Its location creates significant challenges for achieving clear surgical margins necessary to achieve local tumor control while preserving sphincter function to minimize the risk of developing fecal incontinence and other complications.This review summarizes six sphincter-preserving techniques for ultra-low rectal cancer: local excision, low anterior resection(LAR, with or without prophylactic ileostomy or ileal stent), intersphincteric resection (ISR), modified Bacon and Parks procedures, transanal total mesorectal excision (TaTME), and Natural Orifice Specimen Extraction Surgery with Precision Functional Sphincter-Preserving Surgery(NOSES-PPS). While most approaches achieve satisfactory oncological outcomes, postoperative anal function remains a major concern. Preliminary evidence suggests NOSES-PPS may offer benefits in preserving anal function, though current studies are limited by small sample sizes and lack of large-scale trials. Optimal outcomes depend on patient selection, surgical expertise, and perioperative management.