Evaluation of the frequency and pattern of local recurrence following intersphincteric resection for ultra-low rectal cancer

Abdel-Gawad, W.; zaghloul, Ashraf; Fakhr, Ibrahim; Sakr, Mahmoud; Shabana, A; Lotayef, Mohamed; Mansour, O.

doi:10.1016/j.jnci.2014.02.001

Cited by 12 publications

(10 citation statements)

References 34 publications

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“…Our experiences confirm the results of Laurent et al which state that laparoscopic intersphincteric rectal resection gives acceptable clinical outcomes [ 31 ]. Moreover, intersphincteric resection provides good oncological outcomes, comparable to APR [ 39 – 41 ]. Also, TaTME procedures yield satisfactory results concerning the quality of pathological specimens with a proper resection margin.…”

Section: Discussionmentioning

confidence: 99%

A quest for sphincter-saving surgery in ultralow rectal tumours—a single-centre cohort study

et al. 2018

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IntroductionDespite the progress in the treatment of colorectal cancer, there is still no optimal strategy for tumours located adjacent to the anal sphincter. This study aims to evaluate oncological and functional results of surgery for rectal cancer in unfavourable locations in proximity to anal sphincters.Materials and methodsPatients with rectal cancer, which was either initially infiltrating the anal sphincter or located in the close proximity of the sphincter, were included in the study. Patients were submitted to extralevator abdominoperineal resection (APR), intersphincteric resection, or transanal total mesorectal excision (TaTME). Primary outcomes were perioperative data: operative time, blood loss, complications, length of stay (LOS), and 30-day mortality. Secondary outcomes were pathological quality of the specimens and functional outcome 6 months after defunctioning ileostomy closure.ResultsAmong patients with cancer adjacent to the anal sphincter, 13 (25%) underwent APR, 14 (27%) patients were submitted to intersphincteric resection, and 25 (48%) patients were treated with the TaTME approach. Operative time was 240 (210–270 IQR) for APR, 212.5 (170–260 IQR) for intersphincteric resection, and 270 (240–330 IQR) for TaTME (p = 0.018). Perioperative morbidity was 31% for APR, 36% for intersphincteric resections, and 12% for the TaTME group (p = 0.181). Complete mesorectal excision was achieved in 92% of specimens in the TaTME group, 93% in intersphincteric resections, and 78% in the APR group (p = 0.72). Median circumferential resection margin in APR was 6 mm (4–7 IQR), in intersphincteric resections 7.5 mm (2.5–10 IQR), and in the TaTME group 4 mm (2.8–8 IQR). All patients after intersphincteric resections developed major low anterior resection syndrome (LARS). Four patients in the TaTME group developed minor LARS, and 21 had major LARS.ConclusionSphincter-saving rectal resections are a feasible alternative to APR with good clinical, pathological, and oncological outcomes. Intersphincteric resections and TaTME seem to be equal in terms of clinicopathological results. The functional outcome is yet to be investigated.Trial registrationThe study was retrospectively registered in Thai Clinical Trials Registry (23-07-2018, ID TCTR20180724001).

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Section: Discussionmentioning

confidence: 99%

A quest for sphincter-saving surgery in ultralow rectal tumours—a single-centre cohort study

et al. 2018

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“…The intersphincteric dissection for ISR is usually started in the transabdominal phase and completed during the perineal phase [ 19 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ]. 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 single-stage transabdominal ISR with no need for a perineal intersphincteric dissection [ 67 , 68 ].…”

Section: Definition Of Isrmentioning

confidence: 99%

“…However, the Japanese experience on ISR has modified the original classification into three types (Figure 4) [41,42]: The intersphincteric dissection for ISR is usually started in the transabdominal phase and completed during the perineal phase [19,[43][44][45][46][47][48][49][50][51][52][53][54][55][56][57]. 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%

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

Piozzi

Baek

Kwak

et al. 2021

Cancers

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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.

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“…Abdel-Gawad et al . [42] (low-lying rectum) Ghezzi et al . [34] Brazil/Italy (2014) 3.2 18.5 73.2% (5-year) 85.2% (5-year) 37.3% 0% 62.7%…”

Section: Authors' Contributionsmentioning

confidence: 99%

Robotic-assisted total mesorectal excision in low-lying rectal cancer

Chen¹,

Huang²,

Tsai³

et al. 2018

MIS

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Aim: To evaluate the feasibility, safety, and short-term oncological outcomes of robotic-assisted total mesorectal excision (TME) in patients with low-lying rectal cancer (≤ 5 cm from anal verge). Methods: We enrolled 60 patients with stages I-III low-lying rectal cancer who underwent robotic-assisted TME at a single institution between July 2013 and April 2017. Results: Of the 60 patients enrolled, 49 (81.6%) underwent preoperative concurrent chemoradiotherapy. Furthermore, among these 49 patients, 18 (36.7%) achieved a pathologic complete response. R0 resection was performed in 57 (95%) patients. Circumferential and distal resection margins were positive in 3 (5%) and 1 (1.6%) patients, respectively. The sphincter preservation rate was 93.3% (56/60). The overall complication rate was 21.7% (13/60), with an anastomotic leakage rate of 3.3% (2/60); most of these instances were mild and the patient recovered uneventfully. Conclusion: The results demonstrate that robotic-assisted TME is safe and feasible for patients with low-lying rectal cancer.

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Evaluation of the frequency and pattern of local recurrence following intersphincteric resection for ultra-low rectal cancer

Abstract: Intersphincteric resection with TME does not affect the local recurrence or overall survival rate in early rectal cancer T1-2 & 3, with preservation of bowel continuity and better life quality.

Cited by 12 publications

References 34 publications

A quest for sphincter-saving surgery in ultralow rectal tumours—a single-centre cohort study

A quest for sphincter-saving surgery in ultralow rectal tumours—a single-centre cohort study

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

Robotic-assisted total mesorectal excision in low-lying rectal cancer

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