Completely abdominal intersphincteric resection for lower rectal cancer: feasibility and comparison of robot-assisted and open surgery

Abstract

Completely abdominal ISR may be feasible in the treatment of LRC, based on a short-term study. Furthermore, RA ISR had equivalent oncological outcomes and slightly improved functional recovery relative to open ISR.

Outcomes of ultra-low anterior resection combined with or without intersphincteric resection in lower rectal cancer patients

“…In most previous studies, peranal intersphincteric dissection was performed in patients undergoing ISR [3,4,6,13]. Although some surgeons consider the caudal segment below the border of the levator ani as Brectal no-man's land^ [14], in the present study, most partial or subtotal intersphincteric dissections with rectal excision were successfully performed using a transabdominal approach as our previous report [5]. The conventional two-sided approach frequently results in a resected rectum of uneven thickness due to the dissection from two opposite directions [4,13].…”

“…10 Sum was total scores of the five parameters c According to the Dindo's classification of surgical complications 11 d Including two cases of deep vein thrombosis in the ISR+ group, two cases of acute renal failure in the ISR− group, and one case of pulmonary embolism in the ISR+ group e All voiding difficulty occurred until 1 month postoperatively except for one case of each in the two groups using clean intermittent catheterization f None to mild (scales 0-1)/moderate (scales 2-3)/severe (scales 4-5) dysfunction, measured on an analogue scale compared with preoperative state in 252 male patients ≤65 years of age. p value, none to mild dysfunction (scales 0-1) vs. moderate to severe dysfunction (scales [2][3][4][5] differences between the two groups (ISR+ vs. ISR−, 3.8 vs. 5.1 %, p=0.58) (Fig. 2a).…”

“…Anastomotic complications, including leakage, stricture, and enteric fistula, occurred in 18 (2.9 %) patients in the two groups, with no difference between the two groups. On multivariate analysis, anastomotic complications were significantly correlated with local recurrence (odds ratio (OR), 5 Substantial voiding dysfunction (>1/3 functional impairment) occurred in 5.4 % of all patients who underwent uLAR without differences between the two groups. Prolonged dysfunction (>1 month) requiring clean intermittent catheterization was observed in one patient in each group.…”

“…The occurrence of general postoperative complications was evaluated for 2 years postoperatively. Male sexual dysfunction was assessed at 2 years postoperatively in 252 patients (76.8 %) aged ≤65 years (ISR+ group vs. ISR− group, 127 vs. 125 patients), evaluating erectile firmness and ejaculatory frequency using an analogue scale, i.e., none to mild (0-1), moderate (2)(3), and severe (4)(5). Anorectal manometry was administered under the conditions of patient consent at baseline (ISR+ group vs. ISR− group, 176 vs. 122 patients) and at three postoperative periods of 6 months (2 months after restoration of intestinal continuity, 129 vs. 46 patients), 12 months (140 vs. 64 patients), and 24 months (90 vs. 65 patients).…”

“…In patients undergoing uLAR, sphincter damage with concurrent development of a defecation disorder, the so called anterior resection syndrome, occurs to some extent [5,6]. Depending on the extent of sphincter resection, anastomosis level, and other factors, urgency and fecal incontinence occur in 50-60 % of patients.…”