Intersphincteric Resection for Very Low Rectal Adenocarcinoma: Univariate and Multivariate Analyses of Risk Factors for Recurrence

Aoki, Takayuki; Takawa, Masashi; Yamamoto, Seiichiro; Ishiguro, Seiji; Yamaguchi, Takashi; Fujita, Shin; Moriya, Yoshihiro; Nakanishi, Yukihiro

doi:10.1245/s10434-008-0047-3

Cited by 52 publications

(34 citation statements)

References 27 publications

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“…In the early stages, it was unclear whether there was an increased risk of local recurrence with ISR; however, recent studies have shown that short-term outcomes and oncological results after ISR are satisfactory in patients with low rectal cancer [4,5,6,7,8,9,16,17]. Unfortunately, most of these reports have involved open ISR, whereas there have been few reports on laparoscopic ISR.…”

Section: Discussionmentioning

confidence: 99%

“…The techniques of open and laparoscopic ISR have been thoroughly described previously [7,8,9,14,15]. After mobilization of the left colon and splenic flexure, intracorporeal high ligation of the inferior mesenteric vessels was performed.…”

Section: Methodsmentioning

confidence: 99%

“…In previous reports, we have demonstrated that open ISR for rectal cancer is technically feasible and oncologically safe; however, laparoscopic ISR is still not an established technique, and there are only a few reports on the use of this procedure [7,8,9,10,11,12]. Moreover, due to the lack of comparative study, it is currently still controversial as to whether laparoscopic ISR can be regarded as a minimally invasive surgery.…”

Section: Introductionmentioning

confidence: 99%

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Short-Term Outcomes of Laparoscopic Intersphincteric Resection for Lower Rectal Cancer and Comparison with Open Approach

et al. 2011

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Background/Aims: To evaluate the short-term surgical outcomes of laparoscopic intersphincteric resection (ISR) for lower rectal cancer, and to compare them with a case-control series of open ISR. Methods: Between July 2002 and March 2011, 29 patients with lower rectal cancer underwent laparoscopic ISR, and 22 of 29 patients who underwent laparoscopic ISR were compared with the control open ISR group of patients matched for age, gender, operative procedure and pathological stage. Results: There was no perioperative mortality, 8 complications occurred in 7 patients, and the morbidity rate was 24.1% (7/29). Leakage occurred in 1 patient (3.4%) in the laparoscopic ISR group. Regarding the matched case-control study, the operative time was significantly longer (p = 0.0007), but blood loss was significantly lower (p = 0.0003) in the laparoscopic ISR group. The median postoperative hospital stay was 8 days in the laparoscopic ISR group, which was significantly shorter than in the open ISR group (14 days). Postoperative complication rates were similar. In the laparoscopic ISR group, the levels of C-reactive protein on postoperative days 1–3 were significantly lower than in the open ISR group. Conclusions: Laparoscopic ISR for lower rectal cancer provides benefits in the early postoperative period without increasing morbidity or mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Short-Term Outcomes of Laparoscopic Intersphincteric Resection for Lower Rectal Cancer and Comparison with Open Approach

et al. 2011

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“…It is considered that the risk of local recurrence is more likely due to circumferential margin involvement than to distal margin involvement. Risk factors for local and distant recurrence after ISR were reported by Akasu et al Local recurrence rate was 6.7% and distant recurrence was 13% (Akasu et al, 2008). In the multivariate analysis, risk factors for local recurrence included positive microscopic resection margins, focal differentiation of tumor (tumor budding) and elevated preoperative levels of CA 19-9 (> 37 U/ml).…”

Section: Oncologic Outcomesmentioning

confidence: 78%

Rectal Cancer - Staging and Surgical Approach

Pramateftakis¹,

Vasileios²,

Michalopoulos³

et al. 2012

Advances in Cancer Management

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“…Other risk factors for local recurrence include, dedifferentiation of the tumor, and preoperative CA19-9 levels above 37 U/mL [45] , while pathological N1 and N2 tumor and poorly differentiation of the tumor, have been reported as risk factors for distant recurrence [45] .…”

Section: Oncological Outcomementioning

confidence: 99%

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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Intersphincteric Resection for Very Low Rectal Adenocarcinoma: Univariate and Multivariate Analyses of Risk Factors for Recurrence

Cited by 52 publications

References 27 publications

Short-Term Outcomes of Laparoscopic Intersphincteric Resection for Lower Rectal Cancer and Comparison with Open Approach

Short-Term Outcomes of Laparoscopic Intersphincteric Resection for Lower Rectal Cancer and Comparison with Open Approach

Rectal Cancer - Staging and Surgical Approach

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

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