Risk factors for local recurrence and long term survival after minimally invasive intersphincteric resection for very low rectal cancer: Multivariate analysis in 161 patients

Piozzi, Guglielmo Niccolò; Park, Hyunmi; Lee, T.H.; Kim, Ji Sean; Choi, Hoon; Baek, Se Jin; Kwak, Jungwon; Kim, J.; Kim, S.H.

doi:10.1016/j.ejso.2021.03.246

Cited by 11 publications

(50 citation statements)

References 44 publications

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“…The authors reported also a nil conversion rate in the RISR group, which can be associated with the high experience of the operator (30 years experience with 4000 rectal cancer operations). Conversion rate is lower compared to published LISR rates (0–21.8%) [ 122 , 130 , 139 , 140 ] and similar to other RISR studies [ 57 ]. In addition, the operators’ physical discomfort was significantly lower in RISR ( p < 0.001) on a visual analog scale; this should be carefully considered as an important factor considering the high technical and psychophysical demand of ISR for the surgeon.…”

Section: Surgical Approach: Open Vs Laparoscopic Vs Roboticsupporting

confidence: 81%

“…The intersphincteric dissection for ISR is usually started in the transabdominal phase and completed during the perineal phase [ 19 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ]. However, some authors perform the intersphincteric dissection in toto only during the perineal phase [ 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ].…”

Section: Definition Of Isrmentioning

confidence: 99%

“…Piozzi et al reported a study on 161 ISR where indication criteria were extended. In this study patients with post nCRT clearance of EAS/LAM infiltration were indicated to ISR independently to T stage if curative resection was considered technically feasible at the pre-operative MRI staging [ 57 ].…”

Section: Indication Of Isrmentioning

confidence: 99%

“…Some authors advise against indicating ISR to patients with infiltration of EAS/LAM, with tumor shrinkage after nCRT, because of the possibility of unexpected residual malignancies [ 62 ]. However, recent studies advocated the indication to ISR if the EAS/LAM infiltration was not evident after nCRT at the restaging MRI [ 56 , 57 ]. Moreover, Park et al reported that the oncological outcomes in their series of ISR after nCRT were less related to the clinical stage showing stratification according to tumor response (for ypT3 3-y DFS 47.4% and 3-y LR 15.1%) [ 56 ].…”

Section: Neoadjuvant Crt and Isrmentioning

confidence: 99%

“…Piozzi et al reported a study of 161 patients submitted to ISR including locally advanced tumors (ypT4; n = 6) not responsive to nCRT [ 57 ]. Between patients with LRs, two were anterior ypT4 that underwent radical ISR resection with negative margins (R0) and negative intraoperative frozen biopsies (outside the boundaries of the ISP).…”

Section: Neoadjuvant Crt and Isrmentioning

confidence: 99%

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

Piozzi

Baek

Kwak

et al. 2021

Cancers

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The surgical management of low-lying rectal cancer, within 5 cm from the anal verge (AV), is challenging due to the possibility, or not, to preserve the anus with its sphincter muscles maintaining oncological safety. The standardization of total mesorectal excision, the adoption of neoadjuvant chemoradiotherapy, the implementation of rectal magnetic resonance imaging, and the evolution of mechanical staplers have increased the rate of anus-preserving surgeries. Moreover, extensive anatomy and physiology studies have increased the understanding of the complexity of the deep pelvis. Intersphincteric resection (ISR) was introduced nearly three decades ago as the ultimate anus-preserving surgery. The definition and indication of ISR have changed over time. The adoption of the robotic platform provides excellent perioperative results with no differences in oncological outcomes. Pushing the boundaries of anus-preserving surgeries has risen doubts on oncological safety in order to preserve function. This review critically discusses the oncological safety of ISR by evaluating the anatomical characteristics of the deep pelvis, the clinical indications, the role of distal and circumferential resection margins, the role of the neoadjuvant chemoradiotherapy, the outcomes between surgical approaches (open, laparoscopic, and robotic), the comparison with abdominoperineal resection, the risk factors for oncological outcomes and local recurrence, the patterns of local recurrences after ISR, considerations on functional outcomes after ISR, and learning curve and surgical education on ISR.

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