Intersphincteric Resection Has Similar Long-term Oncologic Outcomes Compared With Abdominoperineal Resection for Low Rectal Cancer Without Preoperative Therapy: Results of Propensity Score Analyses

Tsukamoto, Shunsuke; Miyake, Makito; Shida, Dai; Ochiai, Hiroki; Yamada, K; Kanemitsu, Yukihide

doi:10.1097/dcr.0000000000001155

Cited by 27 publications

(55 citation statements)

References 28 publications

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“…After 16 years of follow-up, they found that there were no statistically signi cant differences in postoperative survival and recurrence rate between patients with ISR compared with low anterior resection (LAR) and APR [13]. Shunsuke Tsukamoto et al followed up 285 patients (112 ISR and 173 APR) by propensity score matching and found the similar oncologic outcomes for ISR and APR without preoperative chemoradiotherapy in patients with low rectal cancer [14]. In our study, the overall survival, disease-free survival and local recurrence rate were similar between the two groups, R0 resection achieved 100% in both the groups and the number of lymph nodes harvested showed no difference, indicating that oncological outcomes and surgical e cacy were similiar between ISR and APR.…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy of intersphincteric resection for low rectal cancer compared with abdominoperineal resection: a single-center retrospective study

Peng

et al. 2020

Preprint

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Purpose In recent years, intersphincteric resection (ISR) has been increasingly used to replace abdominoperineal resection (APR) for low rectal cancer. This study was to compare the clinical efficacy of ISR and APR. Methods Between 2012 and 2018, 74 consecutive patients with low rectal cancer underwent ISR and APR in our medical centre. The outcomes were retrospectively studied and compared. Results A total of 43 patients underwent ISR and 31 underwent APR were included in the study. No significant differences were found between two groups in gender, age, BMI and ASA score. ISR group showed shorter operative time (P = 0.02) and less blood loss (P = 0.001). Hospital stays, time to soft diet, and postoperative thirty-day complications were not significantly different between the two groups. As for the long-term outcomes, the survival and recurrence rate were similar between two groups. Moreover, LARS score and Wexner score showed the anal function after ISR was generally satisfactory. Conclusion This study suggested that ISR may provide a feasible alternative to APR, with superior short-term outcomes, similar oncological outcomes and satisfactory postoperative anal function.

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Section: Discussionmentioning

confidence: 99%

Clinical efficacy of intersphincteric resection for low rectal cancer compared with abdominoperineal resection: a single-center retrospective study

Peng

et al. 2020

Preprint

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“…In the past 20 years, ISR has been performed as an anus-preserving alternative to avoid the need for permanent colostomy in patients with invasive low rectal cancer located near the anal canal [16,17]. Only a small number of reports have compared the long-term outcomes of ISR with those of APR [14], and very few report descript the LISR. We compared surgical outcomes of patients with ultra-low rectal cancer who underwent duet LISR or LAPR.…”

Section: Discussionmentioning

confidence: 99%

“…Three studies, which included 304 patients, provided available data regarding 5-years survival rate [12,14,15], and showed no statistically signi cant difference between the ISR and APR subgroups (Fig. 2), without heterogeneity across trials, and without publication bias (P = 0.76).…”

Section: -Years Survival Ratementioning

confidence: 99%

“…texts, titles, abstracts, and so on, or a combination of these, and removed the duplicate results. At last, four studies were eligible for this nal meta-analysis [12][13][14][15].…”

Section: Meta-analysismentioning

confidence: 99%

“…The available data for the 5-years recurrence rate was provided by four studies [12][13][14], which included 688 patients. No signi cant difference was noted for the 5-years recurrence rate between the ISR and APR subgroups (Fig.…”

Section: -Years Recurrence Ratementioning

confidence: 99%

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Comparation of Laparoscopic Intersphincteric Resection and Abdominoperineal Resection for Ultra-Low Rectal Cancer Patients - a Retrospective Analysis, and a Meta-analysis of Oncology Outcome

Wang

Qin

et al. 2020

Preprint

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Purpose The aim of the study is to evaluate the surgical and oncology outcomes between laparoscopic Intersphincteric Resection (LISR) and laparoscopic-assisted Abdominoperineal Resection (LARC) for ultra-low rectal cancer patients by using a retrospective analysis, and a meta-analysis of the literature was carried out to further validate the oncology outcome. Patients and methods: Between April 2014 and December 2015, a total of 38 rectal cancer patients who underwent LISR and 41 LARC patients were enrolled in this study. The comparison between the groups was based on clinicopathological characteristics and surgical outcomes. Meta-analysis of published studies, exploring oncology outcome of between LISR and LARC, was carried out using STATA 12.0 software. Results Operating time, blood loss, length of hospital stay, and postoperative complication rates was similar between LISR group and LARC group; Patients undergoing LISR also had a similarly 5-year local recurrence and overall survival rate with LAPR. Meta-analysis showed that five studies, which included a total of 791 patients were final involved for this analysis. Comparing APR, ISR patients obtain similarly 5-years recurrence rate and 5-years survival rate. Conclusion This study suggests that LISR is as technically feasible, safe, and effective as LARC for treating patients with low rectal cancer. Additional high-powered randomized trials are needed to determine whether LISR truly offers any advantages.

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Does anastomotic leakage after intersphincteric resection for ultralow rectal cancer influence long-term outcomes? A retrospective observational study

Liu,

Zhang,

Xiang

et al. 2023

Langenbecks Arch Surg

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To determine whether anastomotic leakage (AL) following intersphincteric resection (ISR) for ultralow rectal cancer (uLRC) is associated with long-term negative outcomes. MethodsBetween June 2011 and January 2022, 236 consecutive patients who underwent ISR with diverting ileostomy for uLRC were included. The primary outcome was long-term clinical consequences of AL, including chronic stricture, stoma reversal, oncological and functional results. ResultsForty-one (17.4%) patients developed symptomatic AL, whereas only two (0.8%) required re-laparotomy due to severe leakage.Patients with leaks had a signi cantly increased incidence of chronic stricture (29.3% vs 8.7%, P = 0.001) and stoma nonreversal (34.1% vs 4.6%, P < 0.0001) than controls. The severe consequences were particularly common in patients with anastomotic separation, resulting in 60% of those presenting with chronic stricture and 50% ending up with stoma nonreversal. After a median follow-up of 59 (range, 7-139) months, AL did not compromise long-term oncological outcomes, including tumor recurrence (9.8% vs 5.6%, P = 0.3), 5-year disease-free and overall survival (73.4% vs 74.8% and 85.1% vs 85.4%, P = 0.56 and P = 0.55). A total of 149 patients with bowel continuity who completed self-assessment questionnaires were enrolled for functional evaluation. The median follow-up was 24 (range, 12-94) months after ileostomy reversal, and functional results were comparable between patients with and without leaks. ConclusionAL is an unfortunate reality for patients who underwent ISR for uLRC, but the rate of severe leakage is limited. Leaks contribute to possible adverse impacts on chronic stricture and stoma non-reversal, especially for patients with anastomotic separation. However, long-term oncological and functional results may not be compromised.

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Intersphincteric Resection Has Similar Long-term Oncologic Outcomes Compared With Abdominoperineal Resection for Low Rectal Cancer Without Preoperative Therapy: Results of Propensity Score Analyses

Abstract: Our findings suggest similar oncologic outcomes for intersphincteric resection and abdominoperineal resection without preoperative chemoradiotherapy in patients with low rectal cancer adjusted for background variables. See Video Abstract at http://links.lww.com/DCR/A661.

Cited by 27 publications

References 28 publications

Clinical efficacy of intersphincteric resection for low rectal cancer compared with abdominoperineal resection: a single-center retrospective study

Clinical efficacy of intersphincteric resection for low rectal cancer compared with abdominoperineal resection: a single-center retrospective study

Comparation of Laparoscopic Intersphincteric Resection and Abdominoperineal Resection for Ultra-Low Rectal Cancer Patients - a Retrospective Analysis, and a Meta-analysis of Oncology Outcome

Does anastomotic leakage after intersphincteric resection for ultralow rectal cancer influence long-term outcomes? A retrospective observational study

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