Intersphincteric resection and hand-sewn coloanal anastomosis for low rectal cancer: Short-term outcomes in the Indian setting

Pai, Vishwas D.; Souza, Ashwin De'; Patil, Prachi; Arya, Supreeta; Saklani, Avanish

doi:10.1007/s12664-014-0522-7

Cited by 9 publications

(7 citation statements)

References 23 publications

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“…The absence of perioperative and postoperative mortality and the low morbidity rate in the present study are consistent with the findings of other studies from similarvolume medical centers, including studies involving the laparoscopic approach. 4,[13][14][15][16] The rate of complications, predominantly wound infection and postoperative pain, was worse in patients who underwent abdominoperineal resection than in those who underwent ISR; this is also consistent with the findings of other studies. 17 Considering the preoperative and postoperative serum CEA and CA 19-9 levels and the absence of local relapse and metastasis during the first year after surgery, we may conclude that the oncologic result of ISR is not compromised.…”

Section: Discussionsupporting

confidence: 89%

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Survival and functional and oncological outcomes following intersphincteric resection for low rectal cancer: short-term results

et al. 2018

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ObjectiveThis study was performed to evaluate the 1-year survival rate and functional outcomes of 20 patients who underwent intersphincteric resection (ISR) for low rectal cancer.MethodsTwenty patients who underwent ISR for low rectal cancer were followed up for 1 year. Complications, functional outcomes objectified by the Wexner score, and oncological outcomes were assessed.ResultsThe short-term survival rate was 100%. The median Wexner score was ≤10 in all patients at 12 months after surgery. Signs of local recurrence were absent, and antigen levels remained within the reference ranges 1 year postoperatively.ConclusionsISR is a feasible alternative in highly selected patients who primarily refuse a colostomy bag and present with type II or III tumors. In the present study, patient-reported continence was satisfactory, and the absence of a colostomy bag increased patients’ quality of life. The oncological outcomes were satisfactory at 1 year postoperatively.

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Section: Discussionsupporting

confidence: 89%

“…All patients reported the acceptance of imperfect continence while lacking a colostomy bag, a finding also reported by other authors. 4 , 5 , 13 , 14 , 21 …”

Section: Discussionmentioning

confidence: 99%

Survival and functional and oncological outcomes following intersphincteric resection for low rectal cancer: short-term results

et al. 2018

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“…To the best of our knowledge, this is the first study to report the long-term outcomes after ISR in Indian patients. An earlier study from Mumbai had analyzed 33 patients who underwent ISR for low rectal cancer and reported a morbidity and 30-day mortality of 6 and 0%, respectively [7]. However, long-term oncological and functional outcomes were not reported in this study.…”

Section: Discussionmentioning

confidence: 70%

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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“…El margen de resección distal en nuestro estudio tuvo una mediana 10 (4-25) mm, Martín et al 7 , informan un promedio de 17,1 (10-29) mm y Akagi et al 8 , entre 5-20 mm. Por otra parte en este trabajo la me-diana del número de linfonodos resecados fue de 11 (1-24) que está dentro del rango (1-37) reportado en la literatura internacional 16,[19][20][21][22] .…”

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Resultados a largo plazo de pacientes con adenocarcinoma de recto inferior tratados con resección anterior ultrabaja interesfintérica

et al. 2019

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Long-term results of patients with adenocarcinoma of the lower rectum treated with anterior intersphinteric ultra-low-resection Introduction: Intersphinteric resection (ISR) allows preserve sphincter function in selected patients with rectal cancer (RC). Notwithstanding, it can produce alterations in defecation. Aim: To analyze the oncological and functional results after an ISR. Materials and Method: Observational, analytical, cross-sectional study, in the period 2007-2016. Inclusion criteria: Patients submitted to ISR by RC with curative intention. All the patients had a follow-up in 2017. Analysis of functional evaluation were performed by Jorge-Wexner, LARS and Kirwan scale. Statistical analysis: Descriptive statistics and Kaplan-Meier method. Results: Of 21 patients; Fourteen (67%) were male, average age: 59 years. Tumor location: 4 cm (2-6 cm) from anal verge. Eighteen (85.7%) patients received neoadjuvant therapy. All distal and radial margins were negative. One patient (4.8%) had distant metastases and there was no locoregional recurrence. With a median follow-up of 76.3 (9.8-126.8) months, the 5-year global and disease-free survival was: 100% and 95% (CI: 90.1-99.9%), respectively. With a median follow-up of 90 months (21.7-124.2); Functional evaluation was performed on 15/21 patients. The Jorge-Wexner score had a median of 13 (4-17) points, the LARS scale of 34 points and in Kirwan scale, four patients (26.7%) showed good function (Kirwan I-II). Conclusion: The oncological results of patients undergoing ISR are satisfactory, however, functional results should be taken into account when proposing this surgical procedure.

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Intersphincteric resection and hand-sewn coloanal anastomosis for low rectal cancer: Short-term outcomes in the Indian setting

Abstract: Intersphincteric resection is feasible and oncologically safe in selected patients with low rectal cancer. Long-term functional and oncological outcomes are essential before it can be considered a viable alternative to APER.

Cited by 9 publications

References 23 publications

Survival and functional and oncological outcomes following intersphincteric resection for low rectal cancer: short-term results

Survival and functional and oncological outcomes following intersphincteric resection for low rectal cancer: short-term results

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

Resultados a largo plazo de pacientes con adenocarcinoma de recto inferior tratados con resección anterior ultrabaja interesfintérica

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