Skip to main content
2026 ASCRS Annual Scientific Meeting Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
CME
CME
Invitation/Ticketed Event
Invitation/Ticketed Event
Invited Lectureship
Invited Lectureship
Award Recipient
Award Recipient
Live Streamed Session
Live Streamed Session
Nurses Contact Hours
Nurses Contact Hours
Self-Assessment
Self-Assessment
Live Q&A and Polling
Live Q&A and Polling
Social
Social
Industry
Industry

Session:: Abstract Session: Rectal Cancer

P301 - Ten-Year Oncologic Outcomes after Sphincter-Preserving Surgery versus Abdominoperineal Resection for Low Rectal Cancer: Long-term Results of the Prospective ASPIRE Study

Saturday, May 9, 2026
3:28 PM - 3:36 PM ET

    Abstract Podium Presenter(s)

  • Ji Won Park, MD, PhD (he/him/his)

    Clinical Professor
    Seoul National University Hospital
    Seoul National University College of Medicine
    Seoul, Seoul-t'ukpyolsi, Republic of Korea

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

    • Author(s)

  • SK

    Sung-Bum Kang, MD,PhD

    Professor
    Seoul National University Bundang Hospital
    Seongnam, Kyonggi-do, Republic of Korea

    Disclosure information not submitted.

  • EY

    Eui Gon Youk, MD, PhD

    Doctor
    Daehang Hospital
    Seoul, Seoul-t'ukpyolsi, Republic of Korea

    Disclosure information not submitted.

  • DL

    Doo-Seok Lee, M.D, Ph.D

    colorectal surgeon
    Daehang Hospital
    Seoul, Seoul-t'ukpyolsi, Republic of Korea

    Disclosure information not submitted.

  • HP

    Hyoung-Chul Park, MD, PhD

    Doctor
    Hallym University Hospital
    Anyang, Kyonggi-do, Republic of Korea

    Disclosure information not submitted.

  • IS

    Iltae Son, n/a

    Department of Surgery
    Hallym medical university hospital
    Anyang, Kyonggi-do, Republic of Korea

    Disclosure information not submitted.

  • SH

    Seung Chul Heo, MD, PhD

    Professor
    Seoul Metropolitan Government Seoul National University Boramae Medical Center
    Seoul, Seoul-t'ukpyolsi, Republic of Korea

    Disclosure information not submitted.

  • RS

    Rumi Shin, n/a

    Clinical Professor
    Seoul National University Boramae Medical Center
    서울특별시, Seoul-t'ukpyolsi, Republic of Korea

    Disclosure information not submitted.

  • SA

    Soyeon Ahn, n/a

    Professor
    Seoul National University Bundang Hospital
    Seongnam, Kyonggi-do, Republic of Korea

    Disclosure information not submitted.

  • HA

    Hong-Min Ahn, n/a

    Assistant professor
    Seoul National University Bundang Hospital
    Seongnam-si, Kyonggi-do, Republic of Korea

    Disclosure information not submitted.

  • HO

    Heung-Kwon Oh, n/a

    Professor
    Seoul National University Bundang Hospital
    Seongnam, Kyonggi-do, Republic of Korea

    Disclosure information not submitted.

  • DK

    Duck-Woo Kim, MD,PhD

    Professor
    Seoul National University Bundang Hospital
    Seongnam, Kyonggi-do, Republic of Korea

    Disclosure information not submitted.

  • SP

    Sung Chan Park, n/a

    Professor
    National Cancer Center
    Seoul, Seoul-t'ukpyolsi, Republic of Korea

    Disclosure information not submitted.

  • DS

    Dae Kyung Sohn, n/a

    Professor
    National Cancer Center
    Goyang, Kyonggi-do, Republic of Korea

    Disclosure information not submitted.

  • MK

    Min Jung Kim, MD, PhD

    Visiting Investigator
    Memorial Sloan Kettering
    New York, New York, United States

    Disclosure information not submitted.

  • Seung-Bum Ryoo, MD, PhD (he/him/his)

    Professor
    Colorectal Surgery division, Surgery department, Seoul national university hospital
    Seoul National University, College of Medicine
    Seoul, Seoul-t'ukpyolsi, Republic of Korea

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

    • Senior Author(s)

  • SJ

    Seung-Yong Jeong, n/a

    Professor
    SNUH
    Seoul, Seoul-t'ukpyolsi, Republic of Korea

    Disclosure information not submitted.

    • Author(s)

  • KP

    Kyu Joo Park, n/a

    Professor
    SNUH
    Seoul, Seoul-t'ukpyolsi, Republic of Korea

    Disclosure information not submitted.

  • JO

    Jae Hwan Oh, MD, PhD

    Professor
    National Cancer Center
    Goyang, Kyonggi-do, Republic of Korea

    Disclosure information not submitted.

Purpose/Background: In the ASPIRE (Abdominoperineal resection versus SPhincter preservation surgery In low REctal cancer) study, which evaluated quality of life as the primary endpoint at 3 years, abdominoperineal resection (APR) was not justified on the grounds of quality-of-life benefit in patients undergoing curative surgery for low rectal cancer (ClinicalTrials.gov: NCT01461525). Although sphincter-preserving surgery (SPS) has become the preferred approach, concerns remain regarding its long-term oncologic safety, particularly in very low rectal tumors. This study aimed to evaluate the 10-year oncologic outcomes of the ASPIRE cohort to determine whether sphincter preservation compromises long-term survival or local control.

Methods/Interventions: ASPIRE was a prospective, multicenter cohort study including patients with low rectal adenocarcinoma (≤5 cm from the anal verge) who underwent curative resection between 2011 and 2016. Patients were categorized into SPS or APR groups. The 10-year outcomes, including overall survival (OS), disease-free survival (DFS), recurrence-free survival (RFS), and local recurrence (LR), were analyzed. Survival outcomes were compared using Kaplan-Meier analysis and log-rank testing. Multivariable Cox regression was performed after adjustment for significant univariate variables. A propensity score-matched (PSM) subgroup analysis was conducted for tumors located ≤3 cm from the anal verge.

Results/Outcomes: Among 342 enrolled patients (268 SPS and 74 APR), the median follow-up duration was 119 months for OS and 102 months for recurrence-related endpoints. The 10-year OS rate was significantly higher in the SPS group compared with the APR group (70.8% vs 61.0%, p = 0.045), whereas no statistically significant differences were observed in RFS (78.0% vs 66.9%, p = 0.11), DFS (64.1% vs 54.6%, p = 0.10), or LR rates (6.2% vs 9.0%, p = 0.66). After adjustment for significant univariate factors in multivariable Cox regression, the difference in overall survival was no longer significant (APR vs SPS: HR 1.24, 95% CI 0.77-1.97, p = 0.38), and no differences were found in RFS (HR 0.96, 95% CI 0.50-1.85, p = 0.91), DFS (HR 0.95, 95% CI 0.53-1.68, p = 0.86), or LR (HR 0.59, 95% CI 0.17-2.07, p = 0.41). In the subgroup of patients with tumors ≤3 cm from the anal verge, survival outcomes remained comparable between SPS and APR even after 1:1 propensity score matching, indicating no oncologic disadvantage to SPS.

Conclusion/Discussion: The 10-year oncologic outcome analysis of the ASPIRE study demonstrated that preemptive APR cannot be justified when performing curative resection for low rectal cancer. These long-term results confirm that SPS is oncologically safe and should remain the preferred surgical approach in appropriately selected patients with low rectal cancer.