Laparoscopic-Assisted Modified Intersphincter Resection for Ultralow Rectal Cancer

Zhou, Haiyang; Ruan, Canping; Wang, Zhiguo; Hu, Zhiqian

doi:10.1245/s10434-017-6280-x

Cited by 5 publications

(2 citation statements)

References 4 publications

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“…For patients with low rectal cancer, anterior resection and abdominoperineal resection (APR) are the standard surgical approaches, both of which require the resection of rectum and even anus and result in the perioperative mortality, anastomotic leak, sexual problems and extensive effects on quality of life (QoL) 2–4. Although anus-preserving surgical approaches have been proposed such as intersphincter resection (ISR) and conformal sphincter preservation operation, there is little probability for patients with ultra-low rectal cancer to preserve the rectum and anus 5 6…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant chemoradiation therapy combined with immunotherapy for microsatellite stable ultra-low rectal cancer (CHOICE II): study protocol of a multicentre prospective randomised clinical trial

Zhou,

Yu,

Wen

et al. 2023

BMJ Open

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IntroductionNeoadjuvant chemoradiotherapy (nCRT) could bring tumour shrinking and downstaging and increase the probability of organ preservation for patients with low rectal cancer. But for ultra-low rectal cancer, there is little possibility for organ preservation. Immunotherapy has been shown to have significant survival benefits in microsatellite instability-high patients but poor response in microsatellite stable (MSS) patients. Studies have demonstrated that radiotherapy and immunotherapy have synergistic effects in cancer treatment. There is no existing evidence about the clinical efficacy of immunotherapy combined with nCRT for patients with MSS ultra-low rectal cancer.Method and analysisThis trial is an open-labelled multicentre prospective randomised controlled trial (NCT05215379) with two parallel groups and allocation ratio 1:1 (nCRT+immunotherapy vs nCRT group). Eligible participants will be aged 18–75 years, with a desire for anus preservation, confirmed cT1–3aN0–1M0rectal adenocarcinoma, confirmed MSS type, inferior margin of ≤5 cm from the anal verge. The primary endpoint of this trial is complete clinical response (cCR) rate. Immunotherapy is added after 1 week of chemoradiotherapy for two cycles, and then the patients will be administered two cycles of immunotherapy and CAPOX. The evaluations will be carried out after the completion of the whole neoadjuvant therapy. We expect the programme to improve the cCR rate and the quality of life for patients with ultra-low rectal cancer.Ethics and disseminationThis trial was approved by the Ethics committee of Changhai Hospital and other medical centres (Grant number:CHEC2022-118). The results of this study will provide further insight into the clinical efficacy of immunotherapy in combination with nCRT in patients with MSS ultra-low rectal cancer.Trial registration numberNCT05215379.

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Section: Introductionmentioning

confidence: 99%

Neoadjuvant chemoradiation therapy combined with immunotherapy for microsatellite stable ultra-low rectal cancer (CHOICE II): study protocol of a multicentre prospective randomised clinical trial

Zhou,

Yu,

Wen

et al. 2023

BMJ Open

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“…Many reports have discussed laparoscopic ISR [ 5 , 7 – 10 ]. Most of these reports have involved dissection of the intersphincteric space based on the laparoscopic TME technique, which is followed by transection of the rectum through the perineum at a safe distance from the distal edge of the tumor under direct vision, and handsewn repair [ 9 , 11 , 12 ]. This operative approach is complicated and technically difficult, particularly because separation of the anterior rectal wall can easily damage the vagina in women (the urethra and prostate may be damaged in men), and many postoperative complications and severe anal functional damage have been noted [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical efficacy of different approaches for laparoscopic intersphincteric resection of low rectal cancer: a comparison study

Zhuang

et al. 2022

World J Surg Onc

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Background The operative results of different approaches for the laparoscopic intersphincteric resection (LAISR) of low rectal cancer vary, and the patient characteristics associated with the best outcomes for each procedure have not been reported. We compared the efficacy of different approaches for LAISR of low rectal cancer and discussed the surgical indications for each approach. Methods We retrospectively reviewed data from 235 patients with low rectal cancer treated via LAISR from October 2010 to September 2016. Patients underwent either the transabdominal approach for ISR (TAISR, n = 142), the transabdominal perineal approach for ISR (TPAISR, n = 57), or the transanal pull-through approach for ISR (PAISR, n = 36). Results The PAISR and TAISR groups exhibited shorter operation times and less intraoperative blood loss than the TPAISR group. The anastomotic distance was shorter in the PAISR and TPAISR groups than in the TAISR group. No differences in the ability to perform radical resection, overall complications, postoperative recovery, Wexner score recorded 12 months after ostomy closure, 3-year disease-free survival, local recurrence-free survival, distant metastasis-free survival, or overall survival (OS) were observed among the three groups. Conclusions TAISR, TPAISR, and PAISR have unique advantages and do not differ in terms of operation safety, patient outcomes, or anal function. TPAISR requires a longer time to complete and is associated with more bleeding and a slower recovery of anal function. PAISR should be considered when TAISR cannot ensure a negative distal margin and the tumor and BMI are relatively small; otherwise, TPAISR is required.

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Laparoscopic intersphincteric resection with hand-sewn coloanal anastomosis in the treatment of low rectal cancer: 10-year experience

et al. 2021

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Laparoscopic-Assisted Modified Intersphincter Resection for Ultralow Rectal Cancer

Abstract: Laparoscopic-assisted modified intersphincter resection for ultralow rectal cancer is safe and feasible. This technique should be considered whenever possible as a means to offer sphincter preservation and improve sphincter function in patients with ultralow rectal cancer.

Cited by 5 publications

References 4 publications

Neoadjuvant chemoradiation therapy combined with immunotherapy for microsatellite stable ultra-low rectal cancer (CHOICE II): study protocol of a multicentre prospective randomised clinical trial

Neoadjuvant chemoradiation therapy combined with immunotherapy for microsatellite stable ultra-low rectal cancer (CHOICE II): study protocol of a multicentre prospective randomised clinical trial

Clinical efficacy of different approaches for laparoscopic intersphincteric resection of low rectal cancer: a comparison study

Laparoscopic intersphincteric resection with hand-sewn coloanal anastomosis in the treatment of low rectal cancer: 10-year experience

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