Intersphincteric Resection Versus Abdominoperineal Resection for Low Rectal Cancer: A Meta-Analysis

Abstract

Background. Abdominoperineal resection (APR) has been the standard surgery for ultra-low rectal cancer for a century. In recent years, intersphincteric resection (ISR) has been increasingly used to avoid the permanent colostomy. Up to now, there is no relevant meta-analysis comparing the clinical efficacy of ISR and APR. This meta-analysis aimed to compare the outcomes of these 2 procedures. Methods. A comprehensive search of online databases was performed on PubMed, EMBASE, and the Cochrane Library to obtain comparative studies of ISR and APR. Then the data from studies that met the inclusion criteria were extracted and analyzed. Results. A total of 12 studies covering 2438 patients were included. No significant differences were found between ISR and APR in gender, body mass index, distance from tumor to anal edge, operative time, and blood loss. In addition, hospital stay (weighted mean differences = −2.98 days; 95% confidence interval [CI] = −3.54 to −2.43; P < .00001) and postoperative morbidity (odds ratio [OR] = 0.76; 95% CI = 0.59 to 0.99; P = .04) were significantly lower in ISR group compared with APR group. However, patients who underwent ISR showed lower pathological T-stage (T3T4%, OR = 0.49; 95% CI = 0.28 to 0.86; P = .01) and lymph node metastasis rate (OR = 0.77; 95% CI = 0.59 to 1.01; P = .06) compared with those who underwent APR. Moreover, oncological outcomes were similar between the 2 groups. Conclusion. ISR may provide a safe alternative to APR, with shorter hospital stays, lower postoperative morbidity, and similar oncological outcomes. Well-designed randomized controlled trials are needed to confirm and update the findings of this analysis.

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

“…ISR is an alternative to APR for very low-lying rectal cancer. Some authors have compared the clinical and oncological results between ISR and APR, however, this should be carefully considered because the indications for these two techniques do not always overlap [ 145 ]. The ISP can be generally considered the anatomical boundary between these two techniques with ISR indicated for tumors not infiltrating the EAS/LAM complex.…”

“…Peng et al performed a meta-analysis on 12 studies comparing ISR and APR for LRC [ 145 ]. The authors reported no significant differences in gender, body mass index, distance from tumor to the anal edge, operative time, and blood loss.…”

“…Furthermore, poorly differentiated adenocarcinomas are an indication of APR. Therefore, patients submitted to ISR are usually younger, with a lower pT stage [145]. As mentioned above, ISR is indicated for type II and III rectal cancers according to Rullier's classification [72], while APR is indicated for type IV.…”

Comparison of Clinical Efficacy and Safety Between da Vinci Robotic and Laparoscopic Intersphincteric Resection for Low Rectal Cancer: A Meta-Analysis

“…In recent years, several new techniques have emerged aiming to preserve anal function under the premise of tumor resection in low rectal cancer. Intersphincteric resection (ISR) is one of the new operations, based on the dissection of the anatomical plane between the internal anal sphincter and the external anal sphincter, making it possible to increase the preservation of the sphincter and avoid a permanent colostomy ( 4 , 5 ).…”

Feasibility Analysis and Advantages of Wedge Resection Plus Transverse Suture Applied to Closure of Loop Ileostomy

“…With the development of treatment technologies such as minimally invasive laparoscopy and internal rectal sphincterotomy, the indications for anus-preserving surgery in patients with rectal cancer have been expanded, and the anus preservation rate for patients with low rectal cancer has been greatly improved (1)(2)(3); however, it also increases the risk of postoperative anastomotic leakage (4,5). Once anastomotic leakage occurs, it will lead to serious complications and consequences, such as pelvic infection, anastomotic stenosis, and defecation dysfunction(6).…”