Complete intersphincteric longitudinal muscle excision May Be key to reducing local recurrence during intersphincteric resection

Kim, Jin Cheon; Kim, Chan Wook; Lee, Jong Lyul; Yoon, Yong Sik; Park, In Ja; Kim, Jung Rang

doi:10.1016/j.ejso.2020.12.017

Cited by 10 publications

(21 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Kim et al have extended the TME concept of resection completeness for surgical quality to ISR through the definition of total intersphincteric longitudinal muscle excision (TILME) [ 68 ]. TILME indicates the en-bloc excision of anorectal tissue adjacent to the EAS including the LM and intervening fibro-fatty tissue.…”

Section: Risk Factors For Oncological Outcomes After Isrmentioning

confidence: 99%

“…The APR rate is heterogeneous between surgeons and countries with still a high rate of patients with LRC undergoing such extensive procedures (29 to 40%) [ 151 , 152 , 153 ]. However, Kim et al recently reported that since the introduction of ISR, the APR rate dropped to 4.9% with a rate of 1.2% in the last fourth quarter of the study [ 68 ]. Moreover, according to the authors, there were no differences in the selection of operative indications during the study period with overlap between the APR and ISR.…”

Section: Isr Vs Aprmentioning

confidence: 99%

“…However, some authors perform the intersphincteric dissection in toto only during the perineal phase [58][59][60][61][62][63][64][65][66]. Park et al and Kim et al have reported the use of the robotic platform to perform total/near-total singlestage transabdominal ISR with no need for a perineal intersphincteric dissection [67,68].…”

Section: Definition Of Isrmentioning

confidence: 99%

See 2 more Smart Citations

Anus-Preserving Surgery in Advanced Low-Lying Rectal Cancer: A Perspective on Oncological Safety of Intersphincteric Resection

Piozzi

Baek

Kwak

et al. 2021

Cancers

View full text Add to dashboard Cite

The surgical management of low-lying rectal cancer, within 5 cm from the anal verge (AV), is challenging due to the possibility, or not, to preserve the anus with its sphincter muscles maintaining oncological safety. The standardization of total mesorectal excision, the adoption of neoadjuvant chemoradiotherapy, the implementation of rectal magnetic resonance imaging, and the evolution of mechanical staplers have increased the rate of anus-preserving surgeries. Moreover, extensive anatomy and physiology studies have increased the understanding of the complexity of the deep pelvis. Intersphincteric resection (ISR) was introduced nearly three decades ago as the ultimate anus-preserving surgery. The definition and indication of ISR have changed over time. The adoption of the robotic platform provides excellent perioperative results with no differences in oncological outcomes. Pushing the boundaries of anus-preserving surgeries has risen doubts on oncological safety in order to preserve function. This review critically discusses the oncological safety of ISR by evaluating the anatomical characteristics of the deep pelvis, the clinical indications, the role of distal and circumferential resection margins, the role of the neoadjuvant chemoradiotherapy, the outcomes between surgical approaches (open, laparoscopic, and robotic), the comparison with abdominoperineal resection, the risk factors for oncological outcomes and local recurrence, the patterns of local recurrences after ISR, considerations on functional outcomes after ISR, and learning curve and surgical education on ISR.

show abstract

Section: Risk Factors For Oncological Outcomes After Isrmentioning

confidence: 99%

Section: Isr Vs Aprmentioning

confidence: 99%

See 1 more Smart Citation

Anus-Preserving Surgery in Advanced Low-Lying Rectal Cancer: A Perspective on Oncological Safety of Intersphincteric Resection

Piozzi

Baek

Kwak

et al. 2021

Cancers

View full text Add to dashboard Cite

show abstract

“…Surgical indications have gradually changed since the first description of ISR from Schiessel et al [ 1 ] in 1994. The widespread of TME, the standardization of nCRT protocols, and the implementation of minimally invasive approaches have further extended the clinical indications to ISR increasing the anus-preserving rate up to astonishing 98.8% as reported by Kim et al [ 35 ] (APR rate of 1.2% in the last quarter of study period). Despite ISR has become more accepted in the last 3 decades, a consensus on the optimal clinical indications is missing and highly needed from the surgical community to standardize the technique, and the oncological, and functional results in future studies, and to implement a multicenter international ISR task force.…”

Section: Discussionmentioning

confidence: 99%

“…A total/near-total transabdominal ISR was described by Kim et al [ 35 ], Park et al [ 47 ], and Huang et al [ 69 ]. This technique allows to fully embrace the technological superiority of the robotic platform by allowing the dissection through the intersphincteric plane and then into the anal canal lumen with a so-called bird’seye view [ 70 ].…”

Section: Discussionmentioning

confidence: 99%

Robotic Intersphincteric Resection for Low Rectal Cancer: Technical Controversies and a Systematic Review on the Perioperative, Oncological, and Functional Outcomes

Piozzi

Kim

2021

Ann Coloproctol

View full text Add to dashboard Cite

Intersphincteric resection (ISR) is the ultimate anus-sparing technique for low rectal cancer and is considered an oncologically safe alternative to abdominoperineal resection. The application of the robotic approach to ISR (RISR) has been described by few specialized surgical teams with several differences regarding approach and technique. This review aims to discuss the technical aspects of RISR by evaluating point by point each surgical controversy. Moreover, a systematic review was performed to report the perioperative, oncological, and functional outcomes of RISR. Postoperative morbidities after RISR are acceptable. RISR allows adequate surgical margins and adequate oncological outcomes. RISR may result in severe bowel and genitourinary dysfunction affecting the quality of life in a portion of patients.

show abstract

Implementation of robot‐assisted curative resection for rare anorectal tumours on the basis of individualised treatment

Kim

Jung

et al. 2021

Robotics Computer Surgery

Self Cite

View full text Add to dashboard Cite

Purpose: To evaluate the validity of robot-assisted curative operation for rare anorectal tumours, characterised by biological heterogeneity and anatomical complexity. Methods:The present study evaluated 16 consecutive patients including three with anorectal squamous cell carcinoma (ARSCC), four with anorectal mucosal melanoma (ARMM), seven with anorectal neuroendocrine tumour (ARNET), and two with other types of anorectal tumours. Results:Of the three patients with ARSCC after chemoradiotherapy, two underwent abdominoperineal resection (APR), and one underwent ultralow anterior resection (uLAR)/total intersphincteric resection (ISR), surviving 56-76 months without recurrence. Of the four ARMM patients, APR and uLAR/total ISR were conducted in two patients, respectively, with variable survival outcomes. All seven patients with ARNET were treated with uLAR/ISR and LAR, surviving for 5-106 months to date. Conclusions:Because most anorectal tumours are confined to the dermal and submucosal layers, robotic anorectal function preserving ISR is expected to achieve R0 resection.

show abstract

Complete intersphincteric longitudinal muscle excision May Be key to reducing local recurrence during intersphincteric resection

Cited by 10 publications

References 26 publications

Anus-Preserving Surgery in Advanced Low-Lying Rectal Cancer: A Perspective on Oncological Safety of Intersphincteric Resection

Anus-Preserving Surgery in Advanced Low-Lying Rectal Cancer: A Perspective on Oncological Safety of Intersphincteric Resection

Robotic Intersphincteric Resection for Low Rectal Cancer: Technical Controversies and a Systematic Review on the Perioperative, Oncological, and Functional Outcomes

Implementation of robot‐assisted curative resection for rare anorectal tumours on the basis of individualised treatment

Contact Info

Product

Resources

About