Background: Non-restorative low anterior resection (NRLAR) may result in inferior oncological outcomes compared to restorative low anterior resection (RLAR) and abdominoperineal resection (APR). While NRLAR is often performed when poor functional or technical challenges are anticipated, comprehensive data on its oncological outcomes remain scarce. This study aimed to retrospectively evaluate the intermediate-term oncological outcomes of patients—who underwent RLAR, NRLAR, or APR for primary rectal cancer. Methods: This analysis included all elective NRLAR, RLAR, and APR procedures for primary rectal carcinoma performed across 11 Dutch centers from 2013 to 2020. The primary outcome was 3-year disease-free survival (DFS). Secondary outcomes included 3-year overall survival (OS) and 3-year local recurrence (LR). KaplanMeier survival analysis with log-rank testing and multivariate Cox regression analysis were employed. Results: A total of 253 (12.5%) patients underwent NRLAR, 1109 (55.0%) RLAR, and 656 (32.5%) APR. NRLAR was associated with a lower 3-year DFS (71.4%) versus RLAR (82.0%) and APR (77.4%) (p= 0.003). The 3-year OS was lower for NRLAR (82.9%) versus RLAR (93.5%) and APR (90.2%) (p< 0.001), with a higher 3-year LR rate for NRLAR (8.1%) versus RLAR (3.3%) and APR (4.5%) (p= 0.003). Multivariate Cox regression analyses confirmed NRLAR as an independent predictor for poorer DFS (HR 1.34; 95% CI: 1.01–1.80;p= 0.046), OS (HR 1.57; 95% CI: 1.04–2.36,p= 0.032), and higher LR risk (HR 2.66; 95% CI: 1.53–4.65;p<= 0.001). Conclusions: NRLAR is associated with poorer intermediate-term oncological outcomes. When technically feasible, restorative options should be considered, and prospective studies are required to further investigate causal relationships.
背景：与恢复性低位前切除术（RLAR）及腹会阴联合切除术（APR）相比，非恢复性低位前切除术（NRLAR）可能导致较差的肿瘤学结局。尽管NRLAR通常在预期功能不良或存在技术挑战时实施，但其肿瘤学结局的综合数据仍较为缺乏。本研究旨在回顾性评估因原发性直肠癌接受RLAR、NRLAR或APR治疗患者的中期肿瘤学结局。 方法：本研究纳入了2013年至2020年间荷兰11个中心实施的所有针对原发性直肠癌的选择性NRLAR、RLAR及APR手术。主要结局指标为3年无病生存率（DFS），次要结局指标包括3年总生存率（OS）和3年局部复发率（LR）。采用Kaplan-Meier生存分析（Log-rank检验）和多变量Cox回归分析进行统计评估。 结果：共有253例（12.5%）患者接受NRLAR，1109例（55.0%）接受RLAR，656例（32.5%）接受APR。与RLAR（82.0%）和APR（77.4%）相比，NRLAR的3年DFS较低（71.4%）（p=0.003）。NRLAR的3年OS（82.9%）低于RLAR（93.5%）和APR（90.2%）（p<0.001），且其3年LR率（8.1%）高于RLAR（3.3%）和APR（4.5%）（p=0.003）。多变量Cox回归分析证实，NRLAR是DFS较差（HR 1.34；95% CI：1.01–1.80；p=0.046）、OS较低（HR 1.57；95% CI：1.04–2.36；p=0.032）以及LR风险较高（HR 2.66；95% CI：1.53–4.65；p≤0.001）的独立预测因素。 结论：NRLAR与较差的中期肿瘤学结局相关。在技术可行的情况下，应考虑选择恢复性手术方案，未来需开展前瞻性研究进一步探究其因果关系。
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