Intersphincteric Resection and Coloanal Anastomosis in Treatment of Distal Rectal Cancer

Cipe, Gokhan; Müslümanoğlu, Mahmut; Yardımcı, Erkan; Memmı, Naim; Ayşan, Erhan

doi:10.1155/2012/581258

Cited by 16 publications

(25 citation statements)

References 58 publications

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“…Particularly, digital examination under anesthesia is important for evaluating tumor mobility, tumor relation to the anal sphincter and final decision making [18][19][20] . A recent systematic review [21] addressed that the method should be ideally applied in T1-3 tumors located within 30-35 mm from the anal verge, with or without internal anal sphincter (IAS) invasion [22] . Absolute contraindications for the method are T4 tumors, invasion of external anal sphincter (EAS), fixed tumors in digital examination (indication that the tumor has broken through the intersphincteric plane), poorly differentiated tumor, poor preoperative sphincter function, distant metastases and presence of mental disease [23] .…”

Section: Selection Of Patientsmentioning

confidence: 99%

“…The anal orifice is then closed transanally with purse string sutures to prevent tumor cell dissemination during the perineal approach [22] . Under direct vision, the dissection is continued cephalad through the intersphincteric space to be connected with the TME plane developed transabdominally [3] .…”

Section: Surgical Techniquementioning

confidence: 99%

“…The continuity of GI tract is then restored by a hand-sewn coloanal anastomosis. Many types of hand sewn anastomosis have been used such as, colonic J-pouch, transverse coloplasty, or straight coloanal hand-sewn anastomosis, according to surgeons preference [22] . Finally, diverting ileostomy or colostomy is performed [21] .…”

Section: Surgical Techniquementioning

confidence: 99%

“…Operative mortality varies between 0% and 1.7%, while postoperative morbidity rate ranges between 8% and 64% [22] . Main causes of morbidity are anastomotic leakage, anastomotic stricture, fistula formation, pelvic sepsis development, wound complications, bleeding and ileus [22] .…”

Section: Early Postoperative Outcomementioning

confidence: 99%

“…Main causes of morbidity are anastomotic leakage, anastomotic stricture, fistula formation, pelvic sepsis development, wound complications, bleeding and ileus [22] . Particularly anastomotic leakage, has been reported as related to postoperative anastomotic stricture formation, cancer recurrence, poor postoperative function and increased operative mortality [36] .…”

Section: Early Postoperative Outcomementioning

confidence: 99%

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Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes

Dimitriou

Michail

Moris

et al. 2015

WJGO

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Low rectal cancer is traditionally treated by abdominoperineal resection. In recent years, several new techniques for the treatment of very low rectal cancer patients aiming to preserve the gastrointestinal continuity and to improve both the oncological as well as the functional outcomes, have been emerged. Literature suggest that when the intersphincteric resection is applied in T1-3 tumors located within 30-35 mm from the anal verge, is technically feasible, safe, with equal oncological outcomes compared to conventional surgery and acceptable quality of life. The Anterior Perineal PlanE for Ultra-low Anterior Resection technique, is not disrupting the sphincters, but carries a high complication rate, while the reports on the oncological and functional outcomes are limited. Transanal Endoscopic MicroSurgery (TEM) and TransAnal Minimally Invasive Surgery (TAMIS) should represent the treatment of choice for T1 rectal tumors, with specific criteria according to the NCCN guidelines and favorable pathologic features. Alternatively to the standard conventional surgery, neoadjuvant chemo-radiotherapy followed by TEM or TAMIS seems promising for tumors of a local stage T1sm2-3 or T2. Transanal Total Mesorectal Excision should be performed only when a board approved protocol is available by colorectal surgeons with extensive experience in minimally invasive and transanal endoscopic surgery. Core tip: The present review presents the most recent advances in the field of sphincter preserving surgery for the treatment of low rectal cancer patients, providing indications, patients' selection, surgical techniques, multimodality approaches, postoperative course and oncological and functional outcomes. In particular, the review focuses on data deriving from prospective EDITORIAL

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Section: Selection Of Patientsmentioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

Section: Early Postoperative Outcomementioning

confidence: 99%

Section: Early Postoperative Outcomementioning

confidence: 99%

See 3 more Smart Citations

Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes

Dimitriou

Michail

Moris

et al. 2015

WJGO

View full text Add to dashboard Cite

show abstract

Oncologic outcomes for low rectal adenocarcinoma following low anterior resection with coloanal anastomosis versus abdominoperineal resection: a National Cancer Database propensity matched analysis

Fields

Scully

Saadat

et al. 2019

Int J Colorectal Dis

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Long-Term Functional and Oncological Outcomes Following Intersphincteric Resection for Low Rectal Cancers

Sivakumar

Seshadri

Veeraiah

2016

Indian J Surg Oncol

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Surgery for low rectal cancer often involves a permanent stoma. Intersphincteric resection (ISR) with colo-anal anastomosis is a valuable sphincter sparing surgical procedure that avoids the need for permanent stoma in patients with low rectal cancer. The aim of this study was to analyze the long-term functional and oncological outcomes following ISR. This was a retrospective analysis of patients with low rectal cancer who underwent ISR with colo-anal anastomosis in our institution between 2007 and 2015. All patients had a diversion stoma. Bowel function outcomes were assessed prospectively using Wexner incontinence score, low anterior resection syndrome score (LARS), and the Cancer Institute Quality of Life (QoL) questionnaire. The histological reports were reviewed to assess the oncological adequacy of the surgery. Patterns of recurrence and survival were analyzed in this group of patients. Thirty-three patients who underwent an ISR were eligible for this study. Laparoscopic resection was performed in five patients. All the patients received neoadjuvant chemoradiation except the two who received short course radiation and one who did not receive any neoadjuvant treatment. The median distance from the anal verge to the distal edge of the tumor was 3 cm (range 1.5-5 cm). Distal resection margins and circumferential resection margins were negative in all the patients. The 30-day post-operative mortality rate was 3.03%. In 20 patients with a median follow-up of 48 months, the 3-year overall survival was 95%. One patient had recurrence in the para-aortic nodes. No patient had a local recurrence. Bowel function was assessed in 18 patients who had a minimum stoma free period of 1 year. After a median of 43 months following stoma closure, the median Wexner score was 3.56 (range 0-19), median LARS score was 4.78 (range 0-33), and the mean Cancer Institute QoL score was 151.56 ± 15.741. The QoL was average to very high with an overall acceptable quality of life. In this study, ISR was associated with acceptable long-term functional and oncological outcomes. It can be considered as a safe alternative to a permanent stoma in selected patients with low rectal cancer.

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Intersphincteric Resection and Coloanal Anastomosis in Treatment of Distal Rectal Cancer

Cited by 16 publications

References 58 publications

Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes

Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes

Oncologic outcomes for low rectal adenocarcinoma following low anterior resection with coloanal anastomosis versus abdominoperineal resection: a National Cancer Database propensity matched analysis

Long-Term Functional and Oncological Outcomes Following Intersphincteric Resection for Low Rectal Cancers

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