Intersphincteric resection for stage I-III low rectal cancer is an oncologically safe alternative to extralevator abdomino-perineal rectal resection

Tulina, Inna; Bredikhin, Mikhail; Герасимов, А. Н.; Krylov, N N; Reshetov, Igor V.; Tsarkov, Petr

doi:10.17116/hirurgia2017461-68

Cited by 4 publications

(3 citation statements)

References 19 publications

(21 reference statements)

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“…After removing duplicates, a total of 820 articles were screened for preliminary titles and abstracts, and then a total of 69 articles were evaluated for eligibility in full text. Among these, 49 articles were excluded because 20 of them were conference abstracts, one was review 19 , and one was non-English article 20 . In addition to these, 13 articles 9 , 21 – 30 had no control group, seven articles 31 – 37 had unavailable data, seven articles 7 , 38 – 43 were not relevant to our study topic, and one article 44 had data that overlapped with a previous articles.…”

Section: Resultsmentioning

confidence: 99%

Oncologic outcomes of intersphincteric resection versus abdominoperineal resection for lower rectal cancer: a systematic review and meta-analysis

Du¹,

Yang²,

Zhang³

et al. 2023

International Journal of Surgery

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Background: The efficacy of intersphincteric resection (ISR) surgery for patients with lower rectal cancer remains unclear compared to abdominoperineal resection (APR). The aim of this study is to compare the oncologic outcomes for lower rectal cancer patients after ISR and APR through a systematic review and meta-analysis. Materials and Methods: A systematic electronic search of the Cochrane Library, PubMed, EMBASE, and MEDLINE was performed through January 12, 2022. The primary outcomes included 5-year disease-free survival (5y-DFS) and 5-year overall survival. Secondary outcomes included circumferential resection margin involvement, local recurrence, perioperative outcomes, and other long-term outcomes. The pooled odds ratios, mean difference, or hazard ratios (HRs) of each outcome measurement and their 95% CIs were calculated. Results: A total of 20 nonrandomized controlled studies were included in the qualitative analysis, with 1217 patients who underwent ISR and 1135 patients who underwent APR. There was no significant difference in 5y-DFS (HR: 0.84, 95% CI: 0.55–1.29; P=0.43) and 5-year overall survival (HR: 0.93, 95% CI: 0.60–1.46; P=0.76) between the two groups. Using the results of five studies that reported matched T stage and tumor distance, we performed another pooled analysis. Compared to APR, the ISR group had equal 5y-DFS (HR: 0.76, 95% CI: 0.45–1.30; P=0.31) and 5y-LRFS (local recurrence-free survival) (HR: 0.72, 95% CI: 0.29–1.78; P=0.48). Meanwhile, ISR had equivalent local control as well as perioperative outcomes while significantly reducing the operative time (mean difference: −24.89, 95% CI: −45.21 to −4.57; P=0.02) compared to APR. Conclusions: Our results show that the long-term survival and safety of patients is not affected by ISR surgery, although this result needs to be carefully considered and requires further study due to the risk of bias and limited data.

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Section: Resultsmentioning

confidence: 99%

Oncologic outcomes of intersphincteric resection versus abdominoperineal resection for lower rectal cancer: a systematic review and meta-analysis

Du¹,

Yang²,

Zhang³

et al. 2023

International Journal of Surgery

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“…A limited number of studies exists that report the long-run oncologic outcome after laparoscopic ISR compared with that after APR. Some studies have reported acceptable oncological outcomes after ISR compared with that after APR [9][10][11]; however, there were some differences in patients' background characteristics and pathological outcomes between ISR and APR groups. In patients with rectal carcinoma, understanding oncologic outcomes is extremely crucial.…”

Section: Introductionmentioning

confidence: 99%

Long-term oncologic outcomes of intersphincteric resection versus abdominoperineal resection for low rectal cancer without preoperative therapy

Huang

et al. 2022

Preprint

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Purpose This study analyzed the oncologic outcomes of patients with low rectal cancer undergoing intersphincteric resection (ISR) compared with those underwent APR to evaluate the oncologic safety of ISR. Methods This study enrolled 149 patients undergoing ISR and 166 patients receiving APR for LRC from January 2010 to December 2020. The exclusion criterion included neoadjuvant therapy or other malignant tumors. Moreover, this study used propensity score matching to reduce possible confounding factors. Results After comparing 123 patients from each group, comparable long-run outcomes were observed in both groups. ISR and APR groups showed 5-year disease-free survival rates of 69.8% and 57.2% (p = 0.146), 5-year overall survival rates of 82.8% and 74.4% (p = 0.164), and 5-year local recurrence-free survival rates of 81.8% and 72.0% (p = 0.109), respectively. For paired patients receiving laparoscopic surgery, close outcomes were observed. Moreover, ISR showed comparable oncologic safety for locally advanced cancer to APR. Conclusions In this study, ISR and APR showed close oncological results regardless of the surgery approach for patients with LRC without neoadjuvant chemoradiotherapy(nCRT). In addition, this study suggested that ISR may be safe for locally advanced cancer if circumferential resection margins could be ensured negative.

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“…Other authors have also evaluated found ISR to be satisfactory from an oncological point of view. In one study, authors report a 3-year disease-free survival in ISR group was 97% and a 5-year disease-free survival was 93% [28].…”

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confidence: 98%

Quality of Life Following Intersphincteric Resections for Low Rectal Cancer: Early Results

Botoncea¹,

Molnar²,

Butiurca³

2019

Cancer Survivorship

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Intersphincteric resections are part of the therapeutic arsenal that preserves the sphincterian apparatus. This chapter analyzes the evolution of rectal surgery leading up to intersphincteric resections, deals with anatomical and oncological aspects in rectal cancer, and finally shows our own personal experience with ISR in a series of 40 cases focusing on oncological outcomes, continence, and defecation. As a conclusion, intersphincteric resection represents a feasible therapeutic option in highly selected cases that exempts the patient from the need of a permanent colostomy bag without compromising oncological principles. The Wexner score system is simple and effective in objectifying continence in patients that undergo this type of surgery.

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Intersphincteric resection for stage I-III low rectal cancer is an oncologically safe alternative to extralevator abdomino-perineal rectal resection

Cited by 4 publications

References 19 publications

Oncologic outcomes of intersphincteric resection versus abdominoperineal resection for lower rectal cancer: a systematic review and meta-analysis

Oncologic outcomes of intersphincteric resection versus abdominoperineal resection for lower rectal cancer: a systematic review and meta-analysis

Long-term oncologic outcomes of intersphincteric resection versus abdominoperineal resection for low rectal cancer without preoperative therapy

Quality of Life Following Intersphincteric Resections for Low Rectal Cancer: Early Results

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