Can Performance of Sphincter-Sparing Surgery Serve as an Outcome Measure for Rectal Cancer?

In the appropriate clinical scenario, sphincter-sparing surgery is a marker of high-quality surgical care for rectal cancer. Improvements in anesthesia, medical care, surgical technique, bowel stapling devices, and better understanding of the pathophysiology of rectal cancer have led to expanding use of sphincter-sparing surgery in rectal cancer treatment. Despite an increased interest in sphincter-sparing surgery techniques for resectable rectal cancers in the past two decades, recent national trends in sphincter preservation indicate that there has been no net change in the use of this technique. Although it is not entirely clear why national sphincter salvage rates remain lower than those reported by “Centers of Excellence,” further research is needed to better delineate the modifiable factors that contribute to low rates of sphincter-sparing surgery. Future improvements in rectal cancer surgery can be achieved with a concerted effort by clinicians at the local or societal level.