Anorectal complications after robotic intersphincteric resection for low rectal cancer

Kuo, Li Jen; Ngu, James Chi Yong; Huang, Yan; Lin, Yen Kuang; Chen, Chia Che; Tong, Yiu Shun; Huang, Szu Chia; Hu, Chia Chen; Tan, Shu Hwa

doi:10.1007/s00464-017-5499-8

Cited by 12 publications

(20 citation statements)

References 19 publications

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“…In this study, the robotic system was more commonly used for the treatment of total ISR, indicating that the robotic system could operate better in small spaces. The clinical outcomes were evaluated and reported to be safe in many studies, while anorectal complications, including oedematous haemorrhoids, anal stenosis, and neorectal mucosal prolapse, were more common after ISR ( 18 ). Regarding the oncological outcome, ISR showed comparable overall survival with APR for patients with low rectal cancer, especially for patients at stage I–II ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Anorectal Dysfunction After Interspincteric Resection in Patients With Low Rectal Cancer

Zhang

Wang

et al. 2021

Front. Surg.

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Purpose: The objective of this study was to explore the risk factors for anorectal dysfunction after intersphincteric resection in patients with low rectal cancer.Methods: A total of 251 patients who underwent intersphincteric resection from July 2014 to June 2020 were included in this study, for which the Kirwan's grade, Wexner score, and anorectal manometric index were used to evaluate the anorectal function and other parameters including demographics, surgical features, and clinical and pathological characteristics. These parameters were analysed to explore the potential risk factors for anorectal function after intersphincteric resection.Results: In the 251 included patients, 98 patients underwent partial intersphincteric resection, 87 patients underwent subtotal intersphincteric resection, and 66 patients underwent total intersphincteric resection. There were 53 (21.1%) patients who had postoperative complications, while no significant difference was observed between the three groups. Furthermore, 30 patients (45.5%) in the total intersphincteric resection group were classified as having anorectal dysfunction (Kirwan's grade 3–5), which was significantly higher than that in the partial intersphincteric resection group (27.6%) and subtotal intersphincteric resection group (29.9%). The mean Wexner score of patients that underwent total intersphincteric resection was 7.9, which was higher than that of patients that had partial intersphincteric resection (5.9, p = 0.002) and subtotal intersphincteric resection (6.4, p = 0.027). The initial perceived volume was lower in the total intersphincteric resection group than in the partial and subtotal intersphincteric resection groups at 1, 3, and 6 months after intersphincteric resection. In addition, the resting pressure, maximum squeeze pressure, and maximum tolerated volume in the total intersphincteric resection group were worse than those in the partial and subtotal groups at 3 and 6 months after intersphincteric resection. Univariate and multivariate analyses suggested that an age ≥65, total intersphincteric resection, and preoperative chemoradiotherapy were independent risk factors for anorectal dysfunction (P = 0.023, P = 0.003, and P = 0.008, respectively). Among the 66 patients who underwent total intersphincteric resection, 17 patients received preoperative chemoradiotherapy, of which 12 patients (70.6%) were classified as having anorectal dysfunction.Conclusion: The current study concluded that age ≥65, total intersphincteric resection, and preoperative chemoradiotherapy were risk factors for anorectal dysfunction after intersphincteric resection. The morbidity of anorectal dysfunction after total intersphincteric resection for patients who received preoperative chemoradiotherapy was relatively high, and the indication should be carefully evaluated.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Anorectal Dysfunction After Interspincteric Resection in Patients With Low Rectal Cancer

Zhang

Wang

et al. 2021

Front. Surg.

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“…Our cases were operated by minimally invasive surgery (MIS) (case 1, robot-assisted; case 2, laparoscope-assisted), which is the same to other previous studies in that most cases were treated by MIS [ 6 , 9 ]. Prolapse can happen with all types of ISR, but it is more common with total ISR.…”

Section: Discussionmentioning

confidence: 92%

“…Two cases in our study are not very old age considering common patient’s age of rectal cancer and rectal prolapse (case 1, 64 years old; case 2, 57 years old). Guraieb-Trueba et al [ 6 ] showed that the average age of patients is 65.6 years in their cohort study of neorectal mucosal prolapse (19 patients), while Kuo et al [ 9 ] reported 2 cases of average age 56.6 years. Based on reported cases, we noticed that it is common to occur in 5th and 6th decade.…”

Section: Discussionmentioning

confidence: 99%

Neorectal Mucosal Prolapse After Intersphincteric Resection for Low-Lying Rectal Cancer: A Case Report

et al. 2021

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Radical resection for low rectal cancer is the mainstay among the treatment modalities. Intersphincteric resection (ISR) is considered a relatively new but effective surgical treatment for low-lying rectal tumor. As the sphincter preserving techniques get popularized, we notice uncommon complication associated with it in the form of rectal mucosal prolapse. We presented 2 rare cases that developed neorectal mucosa prolapse after ISR a complication following low rectal cancer surgery. Although ISR is a safe and effective surgical technique for low rectal cancer, it should be considered to correct modifiable possible risk factors. Also, Delorme procedure is good option for management of neorectal mucosal prolapse.

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“…In the study hospital, the treatment principle for CRC is to perform CCRT 6–8 weeks before surgery when the tumour is classified T3/4 and/or lymph node‐positive. The tumour is assessed using sigmoidoscopy at a distance of 3–5 cm from the anal verge, without external anal sphincter or levator ani muscle invasion (Kuo et al, ).…”

Section: Methodsmentioning

confidence: 99%

Exploring bowel dysfunction of patients following colorectal surgery: A cohort study

Tan

Liao²,

Lee

et al. 2019

Journal of Clinical Nursing

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Aims and objectives To examine changes in patients’ bowel function and to compare patients’ outcome among different operation and treatment after rectal resection. Background Anal‐preserving surgery is the trend of treatment of colorectal cancer and bowel function after surgery needs to be concerned. Design Prospective cohort study. Methods A total of 38 patients with convenience sampling were recruited from a teaching hospital. The low anterior resection syndrome (LARS) score was used to assess bowel function disturbances before discharge and at 1 week, 1 month and 3 months after discharge. We followed the STROBE checklist to ensure rigour in our study. Results Approximately half of the patients experienced major LARS, including daily stool frequency of more than seven times and stool clustering at least once a week. The LARS scores observed at 1 month after discharge were significantly higher than those observed before discharge. Patients who received intersphincteric resection had higher LARS scores compared with those who received other surgeries. Furthermore, patients who underwent concurrent chemoradiotherapy, operation (OP) and chemotherapy had the highest LARS scores compared with those who underwent only an OP. Conclusion The patients experienced varied intestinal dysfunction after surgery based on their treatment plan and surgical method. Nurses should provide individualised health education for these patients. Relevance to clinical practice A health education booklet is recommended to educate patients about LARS symptoms and the techniques to adapt in their daily lives after surgery.

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Anorectal complications after robotic intersphincteric resection for low rectal cancer

Abstract: This is the first study reporting on the clinical outcomes of anorectal status after robotic ISR. Further studies are needed to assess the long-term effects of these anorectal complications.

Cited by 12 publications

References 19 publications

Risk Factors for Anorectal Dysfunction After Interspincteric Resection in Patients With Low Rectal Cancer

Risk Factors for Anorectal Dysfunction After Interspincteric Resection in Patients With Low Rectal Cancer

Neorectal Mucosal Prolapse After Intersphincteric Resection for Low-Lying Rectal Cancer: A Case Report

Exploring bowel dysfunction of patients following colorectal surgery: A cohort study

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