Intersphincteric Resection Is the Optimal Procedure for Very Low Rectal Cancer: Techniques, Morbidity, Oncologic and Functional Outcomes

Abstract

Background: The intersphincteric resection the most extreme form of a sphincter-preserving alternative for the abdominoperineal resection. Aim of the Work: We investigated oncological, functional outcomes and morbidity after ISR. Methods: This retrospective study included 164 patients who underwent ISR with between 2010 and 2015, Male 56.1%, Female 43.9%, with a median age was 54.5 years, Median follow-up time was of 48 months, Average surgical time was 230 min, Median blood loss was 700 mL and median hospital stay was nine days. Mean tumour size was 34 mm. The surgical procedure through a laparotomy (72.

Review of Intersphincteric Resections for Rectal Cancer Treatment

“…Despite most patients achieving the objective of oncologic R0 resection (the loss of internal anal sphincter, rectal reservoir and radiation therapy (RT)), there are reports of ISR outcomes that have been shown to significantly contribute to an unsatisfactory anal continence outcome, impacting on QoL after ISR [8]. Pelvic dissection done by the TME nerve-sparing technique also comes with sexual dysfunction and genitourinary problems following both surgery and RT, due to injury to parasympathetic and sympathetic nerves of the hypogastric plexus nerves, even though the rates are better than APR [3,6,9]. Problems of continence, urgency, stool fragmentation, and soiling due to anal dysfunction, LAR syndrome, are experienced by most patients in the postoperative period and are an inevitable consequence of ISR.…”

“…Colorectal cancer is the third most common cancer, second most common cancer in women, and fourth leading cause of cancer death in the world [1,2]. Radical surgical treatment with Total Mesorectal Excision (TME) is considered the best treatment for cancer found in the lower third of the rectum and has benefits of complete tumor removal, to reduce risk of recurrence, and of improved survival [3,4]. Traditionally, radical treatment of rectal cancer was achieved by total Abdominoperineal Resection (APR) with permanent colostomy, resulting in poor quality of life (QoL) and psychological problems caused by a stoma [1,3,5].…”

“…Radical surgical treatment with Total Mesorectal Excision (TME) is considered the best treatment for cancer found in the lower third of the rectum and has benefits of complete tumor removal, to reduce risk of recurrence, and of improved survival [3,4]. Traditionally, radical treatment of rectal cancer was achieved by total Abdominoperineal Resection (APR) with permanent colostomy, resulting in poor quality of life (QoL) and psychological problems caused by a stoma [1,3,5]. The discovery of safe oncological resection margins, termed Distal Resection Margin (DRM), defined by observed maximum distal mural spread of cancer that rarely exceeds 1 cm, and the discovery that such a resection margin can offer sphincter preservation with acceptable continence, has changed the practice of modern surgery [1,5].…”

Abdominal Anal Resections of the Rectum. Own Results. Intersfincter Resections. Controversial Issues

“…Найбільш детальні дані щодо результатів інтерсфінктерної резекції наводять Al Zedan et al, 2019 [21] з Єгипту, які провели 164 оперативних втручань. За даними авторів післяопераційна ле-тальність становила 1,2%, а ускладнення -14,5%.…”