Abstract
Background Intersphincteric resection (ISR) has been a preferable alternative to abdominoperineal resection (APR) for anal preservation in patients with low rectal cancer. Laparoscopic ISR and robotic ISR have been widely used with the proposal of 2 cm or even 1 cm rule of distal free margin and the development of minimally invasive technology. The aim of this review was to describe the newest advancements of ISR. Methods A comprehensive literature review was performed to identify studies on ISR techniques, preoperative chemoradiotherapy (PCRT), complications, oncological outcomes, and functional outcomes and thereby to summarize relevant information and controversies involved in ISR. Results Although PCRT is employed to avoid positive circumferential resection margin (CRM) and decrease local recurrence, it tends to engender damage of anorectal function and patients' quality of life (QoL). Common complications after ISR include anastomotic leakage (AL), anastomotic stricture (AS), urinary retention, fistula, pelvic sepsis, and prolapse. CRM involvement is the most important predictor for local recurrence. Preoperative assessment and particularly rectal endosonography are essential for selecting suitable patients. Anal dysfunction is associated with age, PCRT, location and growth of anastomotic stoma, tumour stage, and resection of internal sphincter. Conclusions The ISR technique seems feasible for selected patients with low rectal cancer. However, the postoperative QoL as a result of functional disorder should be fully discussed with patients before surgery.
Highlights
Colorectal cancer is the third largest cancer in the world
A laparoscopically accomplished coloplasty pouch is easier to anastomose to the anus without tension, and complete laparoscopic total mesorectal excision (TME) with intersphincteric resection (ISR) is considered to decrease the surgical invasiveness without any additional abdominal incisions except those created for the laparoscopic port sites
Portier et al [67] investigated the oncologic outcomes of ultralow coloanal anastomosis with or without ISR for low rectal cancer, and no difference was noted in 5-year local recurrence rate and overall survival (OS)
Summary
Intersphincteric resection (ISR) has been a preferable alternative to abdominoperineal resection (APR) for anal preservation in patients with low rectal cancer. The aim of this review was to describe the newest advancements of ISR. A comprehensive literature review was performed to identify studies on ISR techniques, preoperative chemoradiotherapy (PCRT), complications, oncological outcomes, and functional outcomes and thereby to summarize relevant information and controversies involved in ISR. PCRT is employed to avoid positive circumferential resection margin (CRM) and decrease local recurrence, it tends to engender damage of anorectal function and patients’ quality of life (QoL). Preoperative assessment and rectal endosonography are essential for selecting suitable patients. The ISR technique seems feasible for selected patients with low rectal cancer. The postoperative QoL as a result of functional disorder should be fully discussed with patients before surgery
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