Latest Advances in Intersphincteric Resection for Low Rectal Cancer

Abstract

Background. Intersphincteric resection (ISR) has been a preferable alternative to abdominoperineal resection (APR) for anal preservation in patients with low rectal cancer. Laparoscopic ISR and robotic ISR have been widely used with the proposal of 2 cm or even 1 cm rule of distal free margin and the development of minimally invasive technology. The aim of this review was to describe the newest advancements of ISR. Methods. A comprehensive literature review was performed to identify studies on ISR techniques, preoperative chemoradiotherapy (PCRT), complications, oncological outcomes, and functional outcomes and thereby to summarize relevant information and controversies involved in ISR. Results. Although PCRT is employed to avoid positive circumferential resection margin (CRM) and decrease local recurrence, it tends to engender damage of anorectal function and patients’ quality of life (QoL). Common complications after ISR include anastomotic leakage (AL), anastomotic stricture (AS), urinary retention, fistula, pelvic sepsis, and prolapse. CRM involvement is the most important predictor for local recurrence. Preoperative assessment and particularly rectal endosonography are essential for selecting suitable patients. Anal dysfunction is associated with age, PCRT, location and growth of anastomotic stoma, tumour stage, and resection of internal sphincter. Conclusions. The ISR technique seems feasible for selected patients with low rectal cancer. However, the postoperative QoL as a result of functional disorder should be fully discussed with patients before surgery.

Single-stapling technique versus hand-sewn anastomosis in inter-sphincteric resection with transanal total mesorectal excision (Super SST): protocol for a multicentre randomized clinical trial

“…Inter-sphincteric resection (ISR) was first proposed by Schiessel in 1994 for more distal locations and combines rectal removal with partial or complete internal anal sphincter excision, followed by restoration with hand-sewn coloanal anastomosis 12 . While ISR has allowed many patients to preserve their anus, conventional transabdominal ISR still has several challenges, including anastomosis-related complications, oncological outcomes, and decreased postoperative anorectal function 13 .…”

“…While SST was originally proposed as an anastomotic technique for cases requiring anastomosis of 2 cm or more above the anorectal junction (ARJ), in “Super SST” the anastomotic line is located near or below the ARJ 4 . Currently, the standard method for anastomotic surgery in ISR is the hand-sewn technique 13 ; however, the superiority of SST over hand-sewn anastomosis in ISR with TaTME has not yet been comprehensively evaluated. Therefore, the Super SST trial is a multicentre randomized clinical trial (RCT) designed to compare short-term postoperative outcomes and long-term anorectal functional outcomes between stapled and hand-sewn anastomoses in ISR with TaTME.…”

Feasibility and advantages analyses of wedge resection without mesentery detached approach 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 – 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 ].…”

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).…”