Abstract
The purpose of this study was to identify factors that have a negative impact on anal function after intersphincteric resection. We evaluated postoperative anal function in 96 patients with very lower rectal cancer who underwent intersphincteric resection by having patients fill out detailed questionnaires at 3, 6, 12, and 24 months after surgery. Univariate and multivariate analysis based on the Wexner incontinence score were used to identify factors associated with poor anal function after intersphincteric resection. The mean Wexner score at 12 months after stoma closure was 10.0. Patients with frequent major soiling showed a Wexner score of >or=16, and this score was used as a cutoff value of poor anal function. In the univariate analysis, poor anal function was significantly associated with a greater extent of excision of the internal sphincter and with preoperative chemoradiotherapy. In the multivariate analysis, preoperative chemoradiotherapy was the only independent factor associated with poor anal function after intersphincteric resection (odds ratio=10.3; 95 percent confidence interval, 2.3-46.3, P < 0.01). Preoperative chemoradiotherapy was identified as the risk factor with the greatest negative impact on anal function after intersphincteric resection, regardless of extent of excision of the internal sphincter.
Highlights
Intersphincteric resection (ISR) has been used to avoid permanent colostomy in very low rectal cancer patients
Patients We reviewed the medical charts of all 30 consecutive patients who had undergone ISR for very low rectal adenocarcinoma between April 2001 and August 2010 at the Department of Surgery, Faculty of Medicine, Kinki University
Incontinence was assessed by the Wexner continence score [24], and we considered anal function to be poor if the Wexner score was 15 or more at 12 months [17,18]
Summary
Intersphincteric resection (ISR) has been used to avoid permanent colostomy in very low rectal cancer patients. Total mesorectal excision (TME) [1], coupled with techniques such as end-anal stapling and coloanal anastomosis using the double-stapling technique (DST) [2], can be used to when the tumor is located close to the dentate line, conventional anterior resection using the interperitoneal approach with DST may not allow a secure distal resection margin 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]. It has been proposed to restore the anal structure, preserve fecal continence, and reduce the numbers of patients requiring a permanent stoma
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