Long Term Results of Modified Intersphincteric Resections for Low Rectal Cancer: A Single Center Experience

Abstract

Background and Objectives: The objective of this article is to evaluate the long-term oncological and functional outcomes following modified intersphincteric resections (ISR) for low rectal cancer. The modified technique consisted of the abandonment of colonic J-pouches, transverse coloplasty, or defunctioning temporary stoma in favor of a direct handsewn coloanal anastomosis (CAA). Material and Methods: Sixty consecutive patients with type II and III (juxta-anal or intra-anal) low rectal tumors underwent modified ISR by the same surgical team and were followed for a period of five years. Functional outcomes using the Wexner Score, postoperative complications, recurrence rates, morbidity, and mortality rates were assessed. Results: The five-year survival rate was 93.3% with a disease-free interval at three years of 98%. Morbidity was 15% (n = 9) consisting of intestinal wall necrosis (n = 6), stenosis (n = 2), and sacral metastasis (n = 1). The Wexner score values were, at 1 year, 8.5 (range, 4–13); at three years 7.2 (range, 2–11); and at 5 years 6.7 (range, 2–12). A second surgery was needed in only one case that showed postoperative transmural necrosis of the colonic wall. Conclusions: In highly selected patients with type II or III low rectal tumors and proper preoperative imaging staging, ISR might be a viable alternative to other techniques such as abdominoperineal resection and low anterior resection, both from a functional and an oncological perspective.

Latest Advances in Intersphincteric Resection for Low Rectal Cancer

“…A crucial prerequisite is a meticulous preoperative evaluation of local tumour spread with rectal magnetic resonance imaging excluding infiltration of the external sphincter [10]. Although ISR was initially applied to treat inflammatory bowel disease, its performance in anal preservation for low rectal cancer has been supported by many studies [11][12][13]. Molnar et al [12] followed up 20 patients with low rectal cancer for one year after ISR, discovering that the shortterm survival rate was 100% and the median Wexner score of all patients was less than 10.…”

“…Lately, the fecoflowgrams calculated from defecography has also been a promising assessment of defecation after ISR [86]. Functional results after ISR reported by several studies [7,11,60,80,[87][88][89][90][91][92][93][94][95][96][97][98][99] have been summarized in Tables 3 and 4.…”

Video-assisted anal fistula treatment combined with anal fistula plug for treatment of horseshoe anal fistula

“…Thus, plug implantation is associated with the risk of persistent foreign matter resulting in infection and recurrence. 21 , 22 By allowing for direct viewing of the fistula tract, which is not possible with other techniques, VAAFT makes it possible to clean the fistula and thus achieve a higher operative success rate. Our incorporation of the observational advantages of VAAFT with the practical value of the anal fistula plug-based procedure allowed us to explore the value of a novel VAAFT-Plug intervention as a means of reducing complication rates and bolstering sphincter function in patients with horseshoe anal fistulas.…”

Abdominal Anal Resections of the Rectum. Own Results. Intersfincter Resections. Controversial Issues

“…Vlad-Olimpiu Dbtiurca et al, 2019 [20] представили результати власного досвіду виконання даної операції за участю 60 осіб. Післяопераційні ускладнення мали місце у 9 осіб, некроз кишки -у 6 осіб.…”