Abstract
Background and Objectives: The objective of this article is to evaluate the long-term oncological and functional outcomes following modified intersphincteric resections (ISR) for low rectal cancer. The modified technique consisted of the abandonment of colonic J-pouches, transverse coloplasty, or defunctioning temporary stoma in favor of a direct handsewn coloanal anastomosis (CAA). Material and Methods: Sixty consecutive patients with type II and III (juxta-anal or intra-anal) low rectal tumors underwent modified ISR by the same surgical team and were followed for a period of five years. Functional outcomes using the Wexner Score, postoperative complications, recurrence rates, morbidity, and mortality rates were assessed. Results: The five-year survival rate was 93.3% with a disease-free interval at three years of 98%. Morbidity was 15% (n = 9) consisting of intestinal wall necrosis (n = 6), stenosis (n = 2), and sacral metastasis (n = 1). The Wexner score values were, at 1 year, 8.5 (range, 4–13); at three years 7.2 (range, 2–11); and at 5 years 6.7 (range, 2–12). A second surgery was needed in only one case that showed postoperative transmural necrosis of the colonic wall. Conclusions: In highly selected patients with type II or III low rectal tumors and proper preoperative imaging staging, ISR might be a viable alternative to other techniques such as abdominoperineal resection and low anterior resection, both from a functional and an oncological perspective.
Highlights
Intersphincteric resection has long passed the status of a new procedure for low rectal cancer.Ever since Schiessel et al [1] described the technique in 1994, surgeons have studied its benefits and pitfalls
Radiotherapy and chemotherapy are in common use and can lead to downsizing and downstaging, making these adjuvant therapies suited to low rectal cancer [3,4]
European Society for Medical Oncology (ESMO) guidelines recommend the use of risk-adapted treatment based on preoperative staging
Summary
Intersphincteric resection has long passed the status of a new procedure for low rectal cancer.Ever since Schiessel et al [1] described the technique in 1994, surgeons have studied its benefits and pitfalls. European Society for Medical Oncology (ESMO) guidelines recommend the use of risk-adapted treatment based on preoperative staging. This is done by employing either short course-preoperative radiotherapy (SCPRT) or long-course chemoradiotherapy (CRT) [6]. Imaging studies both prior to and after radiotherapy are of the utmost importance in determining the feasibility of ISR, identifying surgical planes, structure involvement, and discovering local recurrence [6,7,8]. The objective of this article is to evaluate the long-term oncological and functional outcomes following modified intersphincteric resections (ISR) for low rectal cancer. A second surgery was needed in only one case that showed postoperative transmural necrosis of the colonic wall
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