Surgical management of rectal cancer: Analysis of procedural patterns and perioperative outcomes in 510 patients

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Abstract Introduction: Effective surgical therapy of rectal cancer necessitates meticulous selection of suitable surgical procedures contingent upon tumour location, stage and patient characteristics. This research examines surgical procedural trends and results in a tertiary care facility in Kashmir. Patients and Methods: A 7-year retrospective–prospective research examined 510 rectal cancer patients who had surgical treatment at SKIMS. Surgical interventions were classified as local excision, low anterior resection (LAR), abdominoperineal resection (APR), Hartmann’s technique and palliative operations. Data about surgical approaches (open, laparoscopic and robotic), perioperative parameters and complications were gathered and analysed. Results: Out of 510 patients, 36 (7.05%) had transanal excision, 280 (54.9%) underwent LAR, 145 (28.4%) received APR, 35 (6.9%) were treated with Hartmann’s surgery and 14 (2.7%) had unresectable disease necessitating palliative interventions. In the cohort undergoing neoadjuvant treatment, the rates of sphincter-preserving surgery were significantly elevated (62.5% compared to 45.1%, P < 0.05). A laparoscopic technique was employed in 178 individuals (34.9%). Conversion to open surgery was performed in 18 instances (10.1%). Conclusion: This institutional experience illustrates the progression of surgical practices, highlighting the growing implementation of sphincter-preserving techniques and less invasive methods. Neoadjuvant treatment profoundly impacts surgical decision-making, facilitating an increased number of sphincter-preserving surgeries. Persistent focus on entire mesorectal excision principles and judicious application of sophisticated surgical methods can enhance oncological and functional results.