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Peer-reviewedCC BY-NC-ND 4.0BMC Gastroenterology

Conformal sphincter preservation operation versus modified Bacon operation for ultralow rectal cancer: a multicenter retrospective study using propensity-score matching and inverse probability of treatment weighting

  • Haibo Ding1,2
  • Binwen Yuan2
  • Ge Sun3
  • Guanyu Yu3
  • Haifeng Gong3
  • Xiaoming Zhu3
  • Zhi Yang2
  • Peng Zha2
  • Xianhua Gao3
  • Zheng Lou3
  • Jian Li2
  • Wei Zhang3
  1. 1Department of General Surgery, School of Medicine, Yangpu Hospital, Tongji University, 450 Tengyue Road, Shanghai, 200090 China
  2. 2Department of Colorectal Surgery, Xiangya Hospital, Central South University, Changsha, 410008 China
  3. 3Department of Colorectal Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, 200433 China
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Abstract

Purpose: This study aimed to compare perioperative results, postoperative anal function, quality of life (QoL), and long-term outcomes between conformal sphincter preservation operation (CSPO) and modified Bacon operation for ultralow rectal cancer.

Methods: Patients with ultralow rectal cancer undergoing CSPO (n = 123) and modified Bacon (n = 109) were included from Changhai and Xiangya Hospital, respectively, between 2011 and 2020. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to balanced baseline characteristics. Anal function was evaluated with Wexner scores and low anterior resection syndrome (LARS) score, and visual analog scale (VAS) for satisfaction. QoL was evaluated via EORTC QLQ-C30 and QLQ-CR38 questionnaires.

Results: After exclusions, 122 patients in the CSPO group and 108 in the modified Bacon group were analyzed. Following adjustment via PSM and IPTW, the CSPO group demonstrated a shorter operative time, postoperative hospital stay, flatus and defecation time, postoperative anal function recovery time, and better satisfaction with anal function compared to the modified Bacon group. Multivariable analysis showed that neoadjuvant radiotherapy (β=-1.184, 95% CI -1.95 to 0.42) and postoperative anal function recovery time (β=-0.184, 95% CI -0.25 to -0.12) significantly contributed to lower satisfaction with anal function.

Conclusion: This retrospective, observational, multicenter study compared CSPO with the modified Bacon for ultralow rectal cancer. Both approaches demonstrated comparable clinical efficacy, functional outcomes, and QoL. However, CSPO showed potential advantages in perioperative recovery, postoperative anal functional recovery, and patient-reported anal function satisfaction. These findings require confirmation in prospective studies.

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Cite

BibTeXRIS
BibTeX
@article{ding2026conformal,
  title = {{Conformal sphincter preservation operation versus modified Bacon operation for ultralow rectal cancer: a multicenter retrospective study using propensity-score matching and inverse probability of treatment weighting}},
  author = {Haibo Ding and Binwen Yuan and Ge Sun and Guanyu Yu and Haifeng Gong and Xiaoming Zhu and Zhi Yang and Peng Zha and Xianhua Gao and Zheng Lou and Jian Li and Wei Zhang},
  journal = {BMC Gastroenterology},
  year = {2026},
  month = aug,
  doi = {10.1186/s12876-026-05206-5},
  url = {https://doi.org/10.1186/s12876-026-05206-5},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Conformal sphincter preservation operation versus modified Bacon operation for ultralow rectal cancer: a multicenter retrospective study using propensity-score matching and inverse probability of treatment weighting
AU  - Haibo Ding
AU  - Binwen Yuan
AU  - Ge Sun
AU  - Guanyu Yu
AU  - Haifeng Gong
AU  - Xiaoming Zhu
AU  - Zhi Yang
AU  - Peng Zha
AU  - Xianhua Gao
AU  - Zheng Lou
AU  - Jian Li
AU  - Wei Zhang
PY  - 2026
DA  - 2026/08/10
JO  - BMC Gastroenterology
DO  - 10.1186/s12876-026-05206-5
UR  - https://doi.org/10.1186/s12876-026-05206-5
AB  - Purpose: This study aimed to compare perioperative results, postoperative anal function, quality of life (QoL), and long-term outcomes between conformal sphincter preservation operation (CSPO) and modified Bacon operation for ultralow rectal cancer.  Methods: Patients with ultralow rectal cancer undergoing CSPO (n = 123) and modified Bacon (n = 109) were included from Changhai and Xiangya Hospital, respectively, between 2011 and 2020. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to balanced baseline characteristics. Anal function was evaluated with Wexner scores and low anterior resection syndrome (LARS) score, and visual analog scale (VAS) for satisfaction. QoL was evaluated via EORTC QLQ-C30 and QLQ-CR38 questionnaires.  Results: After exclusions, 122 patients in the CSPO group and 108 in the modified Bacon group were analyzed. Following adjustment via PSM and IPTW, the CSPO group demonstrated a shorter operative time, postoperative hospital stay, flatus and defecation time, postoperative anal function recovery time, and better satisfaction with anal function compared to the modified Bacon group. Multivariable analysis showed that neoadjuvant radiotherapy (β=-1.184, 95% CI -1.95 to 0.42) and postoperative anal function recovery time (β=-0.184, 95% CI -0.25 to -0.12) significantly contributed to lower satisfaction with anal function.  Conclusion: This retrospective, observational, multicenter study compared CSPO with the modified Bacon for ultralow rectal cancer. Both approaches demonstrated comparable clinical efficacy, functional outcomes, and QoL. However, CSPO showed potential advantages in perioperative recovery, postoperative anal functional recovery, and patient-reported anal function satisfaction. These findings require confirmation in prospective studies.
SN  - 1471-230X
ER  -