Intersphincteric Resection with Direct Coloanal Anastomosis for Ultralow Rectal Cancer

Abstract

The purpose of this study was to evaluate the oncologic and functional outcomes of intersphincteric resection in ultralow rectal cancer. From 2000 to 2007, intersphincteric resection with total mesorectal excision was performed in 40 patients with very low rectal cancer (total intersphincteric resection in 5 patients, partial intersphincteric resection in 23 patients, and partial intersphincteric resection with partial dentate line preservation [modified partial intersphincteric resection] in 12 patients). The preoperative tumor stage was T12N01M0. Morbidity occurred in three patients (anastomotic leakage in one patient, wound infection in two patients), but there was no postoperative mortality. The five-year overall survival rate was 97 percent, and the five-year disease-free survival rate was 86 percent. Patients who underwent a modified partial intersphincteric resection (P = 0.004) or a partial intersphincteric resection (P = 0.008) had significantly better continence than those who underwent total intersphincteric resection, and patients with a diverting stoma had significantly better continence (P = 0.043) than those without a stoma, at 12 months after surgery. Intersphincteric resection is a safe procedure for sphincter-saving rectal surgery in selected patients with very low rectal tumors. A temporary diverting stoma may be beneficial to improve anal function. Modified partial intersphincteric resection under the precondition of radical resection yielded better anal function and a lower rate of incontinence.