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Intersphincteric resection and coloanal anastomosis in treatment of distal rectal cancer.

Cipe G, Muslumanoglu M, Yardimci E, Memmi N, Aysan E - Int J Surg Oncol (2012)

Bottom Line: In the treatment of distal rectal cancer, abdominoperineal resection is traditionally performed.However, the recognition of shorter safe distal resection line, intersphincteric resection technique has given a chance of sphincter-saving surgery for patients with distal rectal cancer during last two decades and still is being performed as an alternative choice of abdominoperineal resection.The second aim is to compare outcomes of patients who underwent intersphincteric resection with the outcomes of patients who underwent abdominoperineal resection.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvari, Istanbul 34090, Turkey.

ABSTRACT
In the treatment of distal rectal cancer, abdominoperineal resection is traditionally performed. However, the recognition of shorter safe distal resection line, intersphincteric resection technique has given a chance of sphincter-saving surgery for patients with distal rectal cancer during last two decades and still is being performed as an alternative choice of abdominoperineal resection. The first aim of this study is to assess the morbidity, mortality, oncological, and functional outcomes of intersphincteric resection. The second aim is to compare outcomes of patients who underwent intersphincteric resection with the outcomes of patients who underwent abdominoperineal resection.

No MeSH data available.


Related in: MedlinePlus

Type of ISR according to amount of excision of the internal anal sphincter. a: partial ISR, b: subtotal ISR, and c: total ISR.
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Related In: Results  -  Collection


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fig1: Type of ISR according to amount of excision of the internal anal sphincter. a: partial ISR, b: subtotal ISR, and c: total ISR.

Mentions: The first step of abdominal part is high ligation of inferior mesenteric artery and left colonic mobilization including takedown of splenic flexure almost all patients. Second step is total mesorectal excision, with sharp dissection along an embryologic plane between the mesorectal fascia and the fascia of the pelvic sidewall and preserving hypogastric plexus nerves according to the method described by Heald [12]. The dissection is performed as distal as possible and the puborectal muscle surrounding lateral and posterior wall of the rectum is exposed at the pelvic floor to facilitating the perineal dissection. The first step of the perineal part of the operation is good exposition of the anal canal via self-retaining retractor (Lone Star Retractor; Lone Star Medical Products Inc., Houston, TX, USA). After injecting 1 mg diluted epinephrine in 20 mL of saline solution which minimized bleeding and facilitating intersphincteric dissection, the mucosa and internal sphincter are circumferentially incised at least 1 cm distance from the distal edge of the tumor. The anal orifice is then closed transanally with pursestring sutures to prevent tumor cell dissemination during the perineal approach. There are 3 types of ISR, called total, subtotal, and partial. When the tumor spread beyond the dentate line, total ISR should be done. The internal sphincter is completely removed, and the distal margin of resection is at the intersphincteric groove. If the distal edge of the tumor is more than 2 cm far from dentate line, subtotal ISR is performed instead of total ISR. The distal resection margin of subtotal ISR is between dentate line and the intersphincteric groove. If the surgeon has a enough distal surgical margin, the distal line of the resection can be on or above the dentate line. This is called parial ISR. The descriptions of 3 type of ISR are shown in Figure 1. Dissection continues through intersphincteric plane to connect with dissection from abdomen.


Intersphincteric resection and coloanal anastomosis in treatment of distal rectal cancer.

Cipe G, Muslumanoglu M, Yardimci E, Memmi N, Aysan E - Int J Surg Oncol (2012)

Type of ISR according to amount of excision of the internal anal sphincter. a: partial ISR, b: subtotal ISR, and c: total ISR.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3368590&req=5

fig1: Type of ISR according to amount of excision of the internal anal sphincter. a: partial ISR, b: subtotal ISR, and c: total ISR.
Mentions: The first step of abdominal part is high ligation of inferior mesenteric artery and left colonic mobilization including takedown of splenic flexure almost all patients. Second step is total mesorectal excision, with sharp dissection along an embryologic plane between the mesorectal fascia and the fascia of the pelvic sidewall and preserving hypogastric plexus nerves according to the method described by Heald [12]. The dissection is performed as distal as possible and the puborectal muscle surrounding lateral and posterior wall of the rectum is exposed at the pelvic floor to facilitating the perineal dissection. The first step of the perineal part of the operation is good exposition of the anal canal via self-retaining retractor (Lone Star Retractor; Lone Star Medical Products Inc., Houston, TX, USA). After injecting 1 mg diluted epinephrine in 20 mL of saline solution which minimized bleeding and facilitating intersphincteric dissection, the mucosa and internal sphincter are circumferentially incised at least 1 cm distance from the distal edge of the tumor. The anal orifice is then closed transanally with pursestring sutures to prevent tumor cell dissemination during the perineal approach. There are 3 types of ISR, called total, subtotal, and partial. When the tumor spread beyond the dentate line, total ISR should be done. The internal sphincter is completely removed, and the distal margin of resection is at the intersphincteric groove. If the distal edge of the tumor is more than 2 cm far from dentate line, subtotal ISR is performed instead of total ISR. The distal resection margin of subtotal ISR is between dentate line and the intersphincteric groove. If the surgeon has a enough distal surgical margin, the distal line of the resection can be on or above the dentate line. This is called parial ISR. The descriptions of 3 type of ISR are shown in Figure 1. Dissection continues through intersphincteric plane to connect with dissection from abdomen.

Bottom Line: In the treatment of distal rectal cancer, abdominoperineal resection is traditionally performed.However, the recognition of shorter safe distal resection line, intersphincteric resection technique has given a chance of sphincter-saving surgery for patients with distal rectal cancer during last two decades and still is being performed as an alternative choice of abdominoperineal resection.The second aim is to compare outcomes of patients who underwent intersphincteric resection with the outcomes of patients who underwent abdominoperineal resection.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvari, Istanbul 34090, Turkey.

ABSTRACT
In the treatment of distal rectal cancer, abdominoperineal resection is traditionally performed. However, the recognition of shorter safe distal resection line, intersphincteric resection technique has given a chance of sphincter-saving surgery for patients with distal rectal cancer during last two decades and still is being performed as an alternative choice of abdominoperineal resection. The first aim of this study is to assess the morbidity, mortality, oncological, and functional outcomes of intersphincteric resection. The second aim is to compare outcomes of patients who underwent intersphincteric resection with the outcomes of patients who underwent abdominoperineal resection.

No MeSH data available.


Related in: MedlinePlus