# Case Report: Sufficient pelvic floor muscle function can retain acceptable postoperative defecation function after in-situ anal reconstruction surgery in patients with ultra-low rectal/anal cancer

## TL;DR

This case report shows that preserving pelvic floor muscles can help maintain bowel control after surgery for ultra-low rectal or anal cancer.

## Contribution

Demonstrates that in-situ anal reconstruction with partial pelvic floor muscle resection can retain acceptable bowel function in selected patients.

## Key findings

- Three patients showed improved bowel control with Wexner and Low Anterior Resection Syndrome scores indicating functional retention.
- Patients could manage fecal incontinence with minimal impact on daily life.
- Surgical approach preserved dignity by avoiding permanent stoma in patients who refused it.

## Abstract

Patients with ultra-low rectal cancer/anal canal cancer generally undergo abdominoperineal resection with sigmoid colostomy. Patients commonly experience poor quality of life postoperatively, often feeling that their dignity is compromised. Some patients are even willing to forego treatment rather than lose their anus. Surgical approaches to fulfill the treatment aspirations of these patients require further investigation.

Three patients with rectal/anal cancer who underwent combined procedures of partial pelvic floor muscle resection and in situ anal reconstruction were included. All patients underwent combined partial pelvic floor muscle resection and in situ anal reconstruction by the same surgeon. At 24 months postoperatively, the Wexner score and Low Anterior Resection Syndrome score of patient 1 were 7 and 18, and she reported effective control of bowel movements. The Wexner score and Low Anterior Resection Syndrome score of patient 2 were 12 and 37. His bowel function had significantly improved, with only one to two incidents of fecal incontinence per week, which did not substantially impact his daily life. The Wexner score and Low Anterior Resection Syndrome score of patient 3 were 16 and 37. He could perceive the urge to defecate and suppress it for up to 20 s.

Patients with good pelvic floor function who strongly refuse permanent stoma can undergo a combination of partial pelvic floor muscle resection and in situ anal reconstruction.