Laparoscopic Transabdominal Approach Partial Intersphincteric Resection for Low Rectal Cancer: Surgical Feasibility and Intermediate-Term Outcome

Chi, Pan; Huang, Shenghui; H, Lin; Lu, Xingrong; Huang, Ying; Jiang, Weizhong; Xu, Zongbin; Chen, Zhifen; Sun, Yanwu; Ye, Daoxiong

doi:10.1245/s10434-014-4085-8

Cited by 32 publications

(37 citation statements)

References 28 publications

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“…Denost et al 17) demonstrated a significant negative correlation between the WIS score and follow-up duration in 101 patients who underwent ISR. Chi et al 28) reported that continence significantly improved over time based on the relationship between the WIS score and follow-up duration. In the present study, as the WIS score improved over time, the VAS score for bowel movement habits increased, and there was a significant negative correlation between the WIS and VAS scores.…”

Section: Discussionmentioning

confidence: 99%

“…While the oncological outcomes of ISR do not differ from those of abdominoperineal resection (APR) [2][3][4][5] , longterm functional outcomes and quality of life (QOL) after ISR have not been adequately studied. A few studies of the long-term functional outcomes and QOL after ISR have targeted Asian races, including the Japanese [6][7][8][9][10] . Among studies performed in Western countries, a systematic review by Martin et al 11) showed that perfect continence was achieved in about half of patients who underwent ISR, but that fecal incontinence, which ranged from incontinence to mild soiling to solid stool, occurred in 11%-63% of patients.…”

Section: Introductionmentioning

confidence: 99%

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Long-term assessment of anorectal function after extensive resection of the internal anal sphincter for treatment of low-lying rectal cancer near the anus

Shiokawa

Funahashi

Kaneko

et al. 2017

J Anus Rectum Colon

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Abstract:Objectives: Intersphincteric resection (ISR) for low-lying rectal cancer (LRC) may induce major problems associated with anorectal function. In this study, we assessed the severity of ISR-induced impairment in anorectal function. Methods: In total, 45 patients followed up regularly !2 years after diverting ileostoma closure were eligible. The patients underwent ISR (n=35) or conventional coloanal anastomosis without resection of the internal anal sphincter (IAS) (n=10) for treatment of LRC from January 2000 to December 2011. We retrospectively compared anorectal function [stool frequency, urgency, Wexner incontinence scale (WIS) score, and patient satisfaction with bowel movement habits on a visual analog scale (VAS) score] for !2 years after stoma closure between the two groups. Results: The median follow-up period was 4.0 years (range, 2.0-6.5 years). Of the total, 17 (48.6%) patients who underwent ISR had poor anorectal function, including two with complete incontinence. Significant differences were found between the groups in the incidence of urgency (p=0.042), WIS score (p=0.024), and defecation disorder with a WIS score of !10 (p= 0.034) but not in stool frequency. Based on the VAS score, 45.7% of patients who underwent ISR were dissatisfied with their bowel movement habits (p=0.041). Conclusions: Extensive resection of the IAS has negative short-and long-term effects on anorectal function.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-term assessment of anorectal function after extensive resection of the internal anal sphincter for treatment of low-lying rectal cancer near the anus

Shiokawa

Funahashi

Kaneko

et al. 2017

J Anus Rectum Colon

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“…In our study, a diverting temporary ileostomy was performed in 61 patients (87%), which is created with usual closure of the ileostomy either 1 month postoperative or after completion of adjuvant therapy. In other studies, the rate of diverting ileostomy in ISR ranged between 77% and 90% [10,12]. A temporary stoma is typically used in an attempt to decrease the incidence of perianastomotic infections and the occurrence of muscular fibrosis of the external anal sphincter.…”

Section: Discussionmentioning

confidence: 99%

Early and Late Functional Outcomes of Anal Sphincter-Sparing Procedures With Total Mesorectal Excision for Anorectal Adenocarcinoma

et al. 2020

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Purpose: The study aims to assess the functional outcome of anal sphincter-sparing procedures (SSP) with total mesorectal excision (TME) for anorectal adenocarcinoma.Methods: In a multicentric, prospective, single-group study in the period between December 2012 and November 2017, 93 patients presented with anorectal adenocarcinoma were included in the study. Sixty-nine patients underwent SSP with TME. SSP included the combined approach of transabdominal TME with intersphincteric resection (ISR) or transanal transabdominal TME. Using the per anal examination scoring system (PASS), postoperative anal function was assessed after 1 year.Results: Bowel motility time was 50±19 hours. The time needed for narcotic analgesia was 54±18.8 hours. Mean hospital stay was 15.4±10.25 days. Incidence of evident fecal incontinence after ISR is 10.6% (7 of 67 cases). The PASS findings of 69 cases are as follows: extremely hypotonic 8.6% (6 cases), slightly hypotonic 26.1% (18 cases), normal tone 58% (40 cases), slightly stenotic 3 cases (4.3%), or occluded 2.9% (2 cases). Urinary dysfunction occurred in 1 case (1.4%). Temporary diversion was performed in 61 patients (87.1%).Conclusion: Sphincter preservation with TME for anorectal adenocarcinoma helps avoid permanent stoma and provides reasonable functional outcomes. PASS is a new application for postoperative assessment of anal function.

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“…El margen de resección distal en nuestro estudio tuvo una mediana 10 (4-25) mm, Martín et al 7 , informan un promedio de 17,1 (10-29) mm y Akagi et al 8 , entre 5-20 mm. Por otra parte en este trabajo la me-diana del número de linfonodos resecados fue de 11 (1-24) que está dentro del rango (1-37) reportado en la literatura internacional 16,[19][20][21][22] .…”

Section: Discussionunclassified

Resultados a largo plazo de pacientes con adenocarcinoma de recto inferior tratados con resección anterior ultrabaja interesfintérica

et al. 2019

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Long-term results of patients with adenocarcinoma of the lower rectum treated with anterior intersphinteric ultra-low-resection Introduction: Intersphinteric resection (ISR) allows preserve sphincter function in selected patients with rectal cancer (RC). Notwithstanding, it can produce alterations in defecation. Aim: To analyze the oncological and functional results after an ISR. Materials and Method: Observational, analytical, cross-sectional study, in the period 2007-2016. Inclusion criteria: Patients submitted to ISR by RC with curative intention. All the patients had a follow-up in 2017. Analysis of functional evaluation were performed by Jorge-Wexner, LARS and Kirwan scale. Statistical analysis: Descriptive statistics and Kaplan-Meier method. Results: Of 21 patients; Fourteen (67%) were male, average age: 59 years. Tumor location: 4 cm (2-6 cm) from anal verge. Eighteen (85.7%) patients received neoadjuvant therapy. All distal and radial margins were negative. One patient (4.8%) had distant metastases and there was no locoregional recurrence. With a median follow-up of 76.3 (9.8-126.8) months, the 5-year global and disease-free survival was: 100% and 95% (CI: 90.1-99.9%), respectively. With a median follow-up of 90 months (21.7-124.2); Functional evaluation was performed on 15/21 patients. The Jorge-Wexner score had a median of 13 (4-17) points, the LARS scale of 34 points and in Kirwan scale, four patients (26.7%) showed good function (Kirwan I-II). Conclusion: The oncological results of patients undergoing ISR are satisfactory, however, functional results should be taken into account when proposing this surgical procedure.

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Laparoscopic Transabdominal Approach Partial Intersphincteric Resection for Low Rectal Cancer: Surgical Feasibility and Intermediate-Term Outcome

Abstract: Laparoscopic APISR can be performed safely and offers similar intermediate-term oncological and functional outcome compared with the open procedure. The oncological adequacy requires long-term follow-up data.

Cited by 32 publications

References 28 publications

Long-term assessment of anorectal function after extensive resection of the internal anal sphincter for treatment of low-lying rectal cancer near the anus

Long-term assessment of anorectal function after extensive resection of the internal anal sphincter for treatment of low-lying rectal cancer near the anus

Early and Late Functional Outcomes of Anal Sphincter-Sparing Procedures With Total Mesorectal Excision for Anorectal Adenocarcinoma

Resultados a largo plazo de pacientes con adenocarcinoma de recto inferior tratados con resección anterior ultrabaja interesfintérica

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