Intersphincteric Resection Pushing the Envelope for Sphincter Preservation

Denost, Quentin

doi:10.1055/s-0037-1606114

Cited by 19 publications

(20 citation statements)

References 66 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In daily practice, we avoid ISR only in patients with reported incontinence episodes. Denost et al reported that with a step-up strategy face to a bad anal function with low fiber diet, bulking agents, glycerol-based enemas, loperamide, sphincter re-education by biofeedback, sacral nerve stimulation, and cecostomy for anterograde enema, only 5% of the patients need a definitive stoma formation due to major and refractory fecal incontinence in their experience (73).…”

Section: Patient Selectionmentioning

confidence: 99%

Ultimate Functional Preservation With Intersphincteric Resection for Rectal Cancer

Collard

Lefèvre

2020

Front. Oncol.

View full text Add to dashboard Cite

The proximity of the very low rectum rectal cancer to the anal sphincter raises a specific problem: how and until when can we preserve the anal continence without compromising the oncological result of the tumor resection? In this situation, intersphincteric resection (ISR) offers an excellent alternative to abdominoperineal resection (APR), but the selection of patients for this option must be extremely precise. This complex choice justifies the simultaneous consideration of an oncological approach with a functional approach in order to provide a full benefit to the patient. When a circumferential resection margin of at least 1 mm can be performed with a distal resection margin of at least 1 cm with or without preoperative radiotherapy, ISR ensures a safety choice. The oncological results of ISR reported in the literature when performed properly found a 5-year disease-free survival of 80.2% with a local recurrence rate of only 5.8%. In parallel to this oncological evaluation, the expected post-operative functional outcome and the resulting quality of life must be properly assessed pre-operatively, since partial or total resection of the internal sphincter impacts significantly on the functional outcome. Based on data from the literature, this work reports the essential anatomical considerations and then the oncological and functional elements indispensables when an anal continence preservation is evoked for a tumor of the very low rectum. Finally, the precise selection criteria and the major surgical principles are outlined in order to guarantee the safety of this modern choice for the patient.

show abstract

Section: Patient Selectionmentioning

confidence: 99%

Ultimate Functional Preservation With Intersphincteric Resection for Rectal Cancer

Collard

Lefèvre

2020

Front. Oncol.

View full text Add to dashboard Cite

show abstract

“…Coupled with increasing knowledge regarding local and lymphatic spread, a level of resection with concomitant sphincter preservation can be achieved in patients with ultralow rectal cancer down to 2 cm from the dentate line. Ultralow and intersphincteric rectal resection with coloanal anastomosis together with neoadjuvant chemotherapy/radiotherapy have led to excellent oncological results, with avoidance of a permanent stoma.…”

Section: Introductionmentioning

confidence: 99%

Randomized clinical trial of prophylactic transanal irrigationversussupportive therapy to prevent symptoms of low anterior resection syndrome after rectal resection

et al. 2019

View full text Add to dashboard Cite

Background Low anterior resection syndrome (LARS) is a frequent problem after rectal resection. Transanal irrigation (TAI) has been suggested as an effective treatment in patients who have developed LARS. This prospective RCT was undertaken to evaluate the effect of TAI as a prophylactic treatment to prevent symptoms of LARS. Methods Patients who had undergone ultralow rectal resection were randomized to start TAI on a daily basis, or to serve as a control with supportive therapy only after ileostomy closure. All patients were seen after 1 week, 1 month and 3 months, and the maximum number of defaecation episodes per day and night documented during follow‐up. Wexner score, LARS score and Short Form 36 questionnaire responses were evaluated in both groups. Results Thirty‐seven patients could be evaluated according to protocol (TAI 18, control 19). The maximum number of stool episodes per day and per night was significantly lower among patients who underwent TAI at 1 month (median 3 versus 7 episodes/day in TAI versus control group, P = 0·003; 0 versus 3 episodes/night, P = 0·001) and 3 months (3 versus 5 episodes per day, P = 0·006; 0 versus 1 episodes/night, P = 0·002). LARS scores were significantly better in the TAI group after 1 month (median 16 versus 32 in control group; P = 0·044) and 3 months (9 versus 31; P = 0·001). A significantly better result in terms of Wexner score was seen in the TAI group after 3 months (median 2 versus 6 in controls; P = 0·046). Conclusion Prophylactic TAI led to a significantly better functional outcome compared with supportive therapy for up to 3 months. Registration number: DRKS00011752 ( http://apps.who.int/trialsearch/).

show abstract

“…It is pity that the number of lymph nodes harvested in the L-ISR of Baek's study was <12, which might cause the result inaccurate ( 14 ). Second, ISR surgery is more applicable for patients with T1 and T2 ( 30 ). Surgeons usually performed shorter resections with minimal lymph node dissection for this kind of tumors ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Clinical Efficacy and Safety Between da Vinci Robotic and Laparoscopic Intersphincteric Resection for Low Rectal Cancer: A Meta-Analysis

Zhang

et al. 2021

Front. Surg.

View full text Add to dashboard Cite

Background and Aims: The intersphincteric resection (ISR) is beneficial for saving patients' anus to a large extent and restoring original bowel continuity. Laparoscopic ISR (L-ISR) has its drawbacks, such as two-dimensional images, low motion flexibility, and unstable lens. Recently, da Vinci robotic ISR (R-ISR) is increasingly used worldwide. The purpose of this article is to compare the feasibility, safety, oncological outcomes, and clinical efficacy of R-ISR vs. L-ISR for low rectal cancer.Methods: PubMed, EMBASE, Cochrane Library, and Web of Science were searched to identify comparative studies of R-ISR vs. L-ISR. Demographic, clinical, and outcome data were extracted. Mean difference (MD) and risk ratio (RR) with their corresponding confidence intervals (CIs) were calculated.Results: Five studies were included. In total, 510 patients were included, of whom 273 underwent R-ISR and 237 L-ISR. Compared with L-ISR, R-ISR has significantly lower estimated intraoperative blood loss (MD = −23.31, 95% CI [−41.98, −4.64], P = 0.01), longer operative time (MD = 51.77, 95% CI [25.68, 77.86], P = 0.0001), hospitalization days (MD = −1.52, 95% CI [−2.10, 0.94], P < 0.00001), and postoperative urinary complications (RR = 0.36, 95% CI [0.16, 0.82], P = 0.02).Conclusions: The potential benefits of R-ISR are considered as a safe and feasible alternative choice for the treatment of low rectal tumors.

show abstract

Intersphincteric Resection Pushing the Envelope for Sphincter Preservation

Cited by 19 publications

References 66 publications

Ultimate Functional Preservation With Intersphincteric Resection for Rectal Cancer

Ultimate Functional Preservation With Intersphincteric Resection for Rectal Cancer

Randomized clinical trial of prophylactic transanal irrigationversussupportive therapy to prevent symptoms of low anterior resection syndrome after rectal resection

Comparison of Clinical Efficacy and Safety Between da Vinci Robotic and Laparoscopic Intersphincteric Resection for Low Rectal Cancer: A Meta-Analysis

Contact Info

Product

Resources

About