Systematic review of outcomes after intersphincteric resection for low rectal cancer

Martin, Seán T.; Heneghan, Helen; Winter, Desmond C.

doi:10.1002/bjs.8677

Cited by 201 publications

(192 citation statements)

References 63 publications

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“…26 Recently, a review of 14 high quality reports including over 1,200 patients was published. 27 An R 0 resection was achieved in 97 % of patients with an average DRM of 1.7 cm and a negative CRM in 96 %. Mean oncologic outcomes were similar to initial reports but ranges varied widely.…”

Section: Intersphincteric Resectionmentioning

confidence: 90%

“…28 Lack of a standardized assessment instrument and inconsistent reporting of functional outcomes in recent, larger series make consensus on functional outcome after ISR difficult. In a review of eight studies reporting outcomes, 11-63 % of patients reported fecal soiling and 30-86 % reported perfect continence 27 with statistical assessment of the data showing wide confidence intervals. The most likely interpretation of the results is that functional outcome after ISR is highly variable.…”

Section: Intersphincteric Resectionmentioning

confidence: 99%

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Sphincter-Sparing Surgery in Patients with Low-Lying Rectal Cancer: Techniques, Oncologic Outcomes, and Functional Results

Bordeianou

Maguire

Alavi

et al. 2014

Journal of Gastrointestinal Surgery

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Background Rectal cancer management has evolved into a complex multimodality approach with survival, local recurrence, and quality of life parameters being the relevant endpoints. Surgical treatment for low rectal cancer has changed dramatically over the past 100 years. Discussion Abdominoperineal resection, once the standard of care for all rectal cancers, has become much less frequently utilized as surgeons devise and test new techniques for preserving the sphincters, maintaining continuity, and performing oncologically sound ultra-low anterior or local resections. Progress in rectal cancer surgery has been driven by improved understanding of the anatomy and pathophysiology of the disease, innovative surgical technique, improved technology, multimodality approaches, and increased appreciation of the patient's quality of life. The patient with a low rectal cancer, once almost universally destined for impotence and a colostomy, now has the real potential for improved survival, avoidance of a permanent stoma, and preservation of the normal route of defecation.Keywords Rectal cancer . Sphincter preservation . Total mesorectal excision . Anterior resection . Intersphincteric resection . Local excision rectal cancer Historical BackgroundThe modern era of rectal cancer surgery began with the description of the abdominoperineal resection (APR) by Miles in 1908. Prior perineal and sacral approaches (e.g., Kraske approach) to rectal cancer resection produced high rates of complications, cancer recurrence, poor quality of life (QOL), and poor overall survival. Miles' operation reflected greater understanding of the natural history of rectal cancer that was based on postmortem examination of his patients after perineal resection. He observed cancerous implants in the pelvic peritoneum, mesorectum, and affected nodes of the left common iliac bifurcation. These findings led him to develop a "cylindrical concept" of the spread of rectal cancer to upward, downward, and lateral zones. 1 The original operation included resection of the rectum, sigmoid, mesorectum, nodes of the iliac bifurcation, and a perineal component to include the anus and levator ani muscles. Postoperative mortality was high initially, but local recurrence decreased

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Section: Intersphincteric Resectionmentioning

confidence: 90%

Section: Intersphincteric Resectionmentioning

confidence: 99%

Sphincter-Sparing Surgery in Patients with Low-Lying Rectal Cancer: Techniques, Oncologic Outcomes, and Functional Results

Bordeianou

Maguire

Alavi

et al. 2014

Journal of Gastrointestinal Surgery

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“…Los pacientes sometidos a una resección abdominoperineal (RAP) tienen una tasa de RL mayor que la resección anterior baja, lo que probablemente refleja un sesgo de selección 10 . El riesgo de RL de la resección interesfintérica en tumores muy bajos es en la actualidad motivo de discusión 11 . En el extremo del abanico, los pacientes con una RL luego de resección local, tienen un mejor pronóstico relativo y mayor posibilidad de lograr una resección R0.…”

Section: Evaluación Preoperatoria De La Rlunclassified

¿se Justifica El Tratamiento De La Recidiva Local Del Cáncer De Recto?

2014

Rev Chil Cir

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Treatment of local relapses of rectal cancerThe treatment of local relapses of rectal cancer requires a multimodal strategy. The preoperative assessment should consider the performance status of the patient, determine the precise anatomical involvement and look for distant metastases. The risk factors for a local relapse are the height of the tumor, the type of intervention, an elevated carcinoembryonic antigen in the preoperative period, the circumferential margin involvement and the stage of the tumor. The prognostic factors for an established local relapse are the type of surgery for the primary tumor (local excision, anterior or abdominoperineal resection), the type of relapse (staging), the presence of symptoms (profound pelvic pain) and specially the possibility of achieving a complete resection. A systematic analysis of 55 reports concluded that a radical resection with curative intention was achieved in 40% of cases. Preoperative external or intraoperative radiotherapy was used in 12 to 97% and 8 to 91% of cases respectively. Thirty days postoperative mortality was 2.2%, the rates of local control of the tumor ranged from 29 to 100% and five years survival was at least 25% with a superior limit of 41%. Although there are no clear guidelines for the management of these patients, there is a growing consensus in the use of preoperative radiotherapy to achieve better surgical results. Therefore a multimodal treatment of local relapses is justified.Key words: Rectal cancer, local relapse, surgery. ResumenEl tratamiento actual de la recidiva local (RL) del cáncer de recto representa un verdadero desafío para el equipo multidisciplinario que debe manejar esta seria complicación con una estrategia de terapia multimodal. La evaluación preoperatoria de la RL considera el status perfomance del paciente y busca establecer el compromiso anatómico preciso, así como descartar enfermedad a distancia. Entre los factores de riesgo para la ocurrencia de una RL destacan la altura del tumor (bajo), el tipo de intervención (RAP), el CEA preoperatorio elevado, la perforación intraoperatoria, el compromiso del margen circunferencial y el estadio del tumor

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“…This procedure proceeds in the left lower quadrant abdominal colostomy patients with a permanent colostomy, and cannot easily accept. In 1992 Braun et al [1].first reported by resection of internal sphincter (intersphincteric resection,ISR) in the treatment of tumor position of Ultralow rectal cancer of the anal 5cm in 2012 Ireland by doctor Martin [2]. System reviews the 14 units were reported, 1289 admits patients with intersphincteric resection for low rectal cancer information, where resection rate(RO) of 97%, operative mortality is 0.8%, 5-year survival rate is an average of 86.3%, 5-year disease-free survival rate was 78.6%, anal function full scale is 51.2%.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Partial or Subtotal Intersphincteric Resection for Lower Rectal Cancer

Chakravarthy¹,

Kumar²,

Shouliang³

et al. 2014

IOSRJDMS

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Systematic review of outcomes after intersphincteric resection for low rectal cancer

Abstract: Oncological outcomes after ISR for low rectal cancer are acceptable, with diverse, often imperfect functional results. These data will aid the clinician when counselling patients considering an ISR for management of low rectal cancer.

Cited by 201 publications

References 63 publications

Sphincter-Sparing Surgery in Patients with Low-Lying Rectal Cancer: Techniques, Oncologic Outcomes, and Functional Results

Sphincter-Sparing Surgery in Patients with Low-Lying Rectal Cancer: Techniques, Oncologic Outcomes, and Functional Results

¿se Justifica El Tratamiento De La Recidiva Local Del Cáncer De Recto?

Laparoscopic Partial or Subtotal Intersphincteric Resection for Lower Rectal Cancer

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