Intersphincteric resection with excision of internal anal sphincter for conservative treatment of very low rectal cancer

Rullier, Éric; Zerbib, Frank; Laurent, Alexis; Bonnel, C.; Caudry, M; Saric, Jean; Parneix, M

doi:10.1007/bf02238569

Cited by 173 publications

(139 citation statements)

References 30 publications

Supporting

Mentioning

131

Contrasting

Unclassified

Order By: Relevance

“…Generally, maximum resting pressure (MRP) is mainly affected by the IAS and, in part, by the EAS 76. MRP gradually recovered over time after ISR,14, 15, 19 and anal function improved over time 23, 27. Some authors reported that colonic J‐pouch anastomosis offered superiority in bowel frequency, urgency control, tolerable volume, Wexner score, and fecal incontinence severity index (FISI)77 compared with the straight anastomosis 20, 43, 78.…”

Section: Discussionmentioning

confidence: 99%

“…ISR is the ultimate anal preservation surgery by both abdominal and anal approaches which consists of TME and excision of the internal anal sphincter. The surgical technique changed the concept of anal preservation and, since 2000, has rapidly expanded not only in Europe, but also in Japan and other Asian countries 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53. Also, laparoscopic‐ISR has come to be aggressively carried out 38, 39, 40, 41, 42.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Intersphincteric resection for very low rectal cancer: A review of the updated literature

Shirouzu

Murakami

Akagi

2017

Annals of Gastroent Surgery

View full text Add to dashboard Cite

Intersphincteric resection (ISR) has rapidly increased worldwide including laparoscopic surgery. However, there are some concerns for the definition of ISR, surgical technique, oncological outcome, anal function, and quality of life (QoL). The aim of the present study is to evaluate those issues. A review of this surgical technique was carried out by searching English language literature of the PubMed online database and appropriate articles were identified. With regard to open‐ISR, the morbidity rate ranged from 7.5% to 38.3%, with lower mortality rates. Local recurrence rates varied widely from 0% to 22.7%, with a mean follow‐up duration of 40–94 months. Disease‐free and overall 5‐year survival rates were 68–86% and 76–97%, respectively. Those outcomes were equivalent to laparoscopic‐ISR. Surgical and oncological outcomes of ISR were generally acceptable. However, accurate evaluation of anal function and QoL was difficult because of a lack of standard assessment of various patient‐related factors. The surgical and oncological outcomes after ISR seem to be acceptable. The ISR technique seems to be valid as an alternative to abdominoperineal resection in selected patients with a very low rectal cancer. However, both necessity for ISR and expectations of QoL impairment as a result of functional disorder should be fully discussed with patients before surgery.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intersphincteric resection for very low rectal cancer: A review of the updated literature

Shirouzu

Murakami

Akagi

2017

Annals of Gastroent Surgery

View full text Add to dashboard Cite

show abstract

“…This is because of the fact that it is impossible to obtain adequate margins from the tumor without damaging the sphincteric structures. Several recent experiences [10][11][12][13][14][15][16][17] suggest that, in selected tumors not infiltrating the levators or the external sphincter, it is possible to achieve a distal margin of 2 cm or more from the tumor, by extending the rectal excision to part of the whole of the internal sphincter and perform a coloanal anastomosis at, or below, the dentate line without major impairment of the anorectal function. The results of this operationknown as an "intersphincteric resection"-which is usually performed using an abdominoendoanal approach, seem to be satisfactory both oncologically and functionally.…”

Section: Discussionmentioning

confidence: 99%

“…The results of this operationknown as an "intersphincteric resection"-which is usually performed using an abdominoendoanal approach, seem to be satisfactory both oncologically and functionally. 14,16,17 Infiltration of the levator muscles and/or the external sphincter (T4 tumors), however, remains an absolute contraindication also for this advanced procedure 11,15 ; preservation of these muscles has been Figure 3. Opening of the pelvic floor with scissors at a distance from tumor after separation of the puborectalis muscle from the external anal sphincter.…”

Section: Discussionmentioning

confidence: 99%

Excision of the Levator Muscles With External Sphincter Preservation in the Treatment of Selected Low T4 Rectal Cancers

Fucini¹,

Elbetti²,

Petrolo³

et al. 2002

Diseases of the Colon &Amp; Rectum

View full text Add to dashboard Cite

PURPOSE:The existence of an anatomic and functional separation between the puborectalis muscle and external anal sphincter permits the performance of an abdominoendoanal excision, instead of an abdominoperineal excision, of the rectum and levator muscles, with preservation of a functioning external sphincter, in selected patients with very low rectal cancer and limited infiltration of the levator muscles. METHODS: Seven patients (4 females; age, 48-69; mean, 60.7 Ϯ 7.8 years) with low posterior or posterolateral localized rectal cancers with infiltration of the puborectalis muscle (T4) were submitted to preoperative chemoradiation and excision of the rectum with the levator muscles, while the external sphincter and its innervation were preserved. A coloanal anastomosis was performed at the dentate line. RESULTS: At a median follow-up of 58 (range, 42-102) months, 6 patients (86 percent) were alive and disease free. No local recurrence was observed. Anorectal function, at three years from surgery was no worse than that of six patients of the same age and gender who had undergone more conventional coloanal anastomoses with preservation of the levator muscles. CONCLUSION: Selected patients with very low rectal cancers infiltrating the levator muscles (T4) and responding to preoperative chemoradiation therapy can still be treated with an advanced sphinctersparing procedure, instead of an abdominoperineal excision. Oncologic and functional results seem to be satisfactory.

show abstract

“…To resolve this problem, partial or total internal sphincteric resection (ISR) and coloanal anastomosis per anus can be used for safe surgical resection of the tumor [6][7][8][9][10][11]. ISR has been proposed to achieve distal clearance in selected patients with very low rectal tumors extending to the upper part of the internal sphincter muscle.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Clinical Factors Associated with Anal Function after Intersphincteric Resection for Very Low Rectal Cancer

Ito

Saitô

Sugito

et al. 2009

Diseases of the Colon &Amp; Rectum

139

104

View full text Add to dashboard Cite

Background: Intersphincteric resection (ISR) has been used to avoid permanent colostomy in very low rectal cancer patients. This study aimed to assess the surgical safety and oncologic and functional outcomes of ISR. Methods: The records of 30 consecutive very low rectal cancer patients who underwent ISR without neoadjuvant therapy were retrospectively analyzed; survival and locoregional recurrence rates were calculated by the Kaplan-Meier method. Incontinence was assessed by a functionality questionnaire and the Wexner score. Results: The median distance between the distal margin of the dentate line was 10 mm. A total of 12, 4, and 14 patients underwent partial ISR, subtotal ISR, and total ISR, respectively. The mean distal resection margin was negative in all cases, and circumferential resection margin was positive in two cases. Morbidity was 33.3%: anastomotic stricture in seven patients, colonic J-pouch prolapse in two patients, and an anovaginal fistula in one patient. During the median, 56.2-month follow-up period, local, distant, and combined recurrences occurred in four, three, and two patients, respectively. The 5-year overall and disease-free survival rates were 76.5% and 68.4%, respectively. Local recurrence rates were 5.2% for the patients with Tis-T2 tumors as compared with 45.5% for those with T3 tumors (P = 0.008). The mean Wexner scores and stool frequencies, 12 months after stoma closure in 19 patients, were 11.5 and 6.6 per 24 h, respectively. Significant differences were not seen in the Wexner scores between partial ISR and subtotal/total ISR (11.8 ± 2.6 and 9.1 ± 5.6). Stool frequency (P = 0.02), urgency (P = 0.04), and fragmentation (P = 0.015) were worse in patients with anastomotic stricture than in those without; there was no symptom improvement in patients with anastomotic stricture. Conclusions: The anastomotic strictures in patients undergoing ISR may have negatively affected anal function. For total ISR patients, at least, informed consent stating the possibility of a permanent colostomy is necessary.

show abstract

Intersphincteric resection with excision of internal anal sphincter for conservative treatment of very low rectal cancer

Cited by 173 publications

References 30 publications

Intersphincteric resection for very low rectal cancer: A review of the updated literature

Intersphincteric resection for very low rectal cancer: A review of the updated literature

Excision of the Levator Muscles With External Sphincter Preservation in the Treatment of Selected Low T4 Rectal Cancers

Analysis of Clinical Factors Associated with Anal Function after Intersphincteric Resection for Very Low Rectal Cancer

Contact Info

Product

Resources

About