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Long-term results of extended intersphincteric resection for very low rectal cancer: a retrospective study.

Kim HS, Ko S, Oh NG - BMC Surg (2016)

Bottom Line: However, at the 24(th) month, the frequencies decreased in both groups, exhibiting no significant difference.In the comparison based on the Kirwan classification, group I showed better continence status than group II but no significant difference.There were no statistically significant differences between the two groups.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, 305 Gudeok-Ro, Seo-Gu, Busan, 602-739, South Korea.

ABSTRACT

Background: Intersphincteric resection (ISR) has become an increasingly popular optional surgical tool for the treatment of very low rectal cancer. The purpose of this study was to assess the long-term oncological and functional outcomes of intersphincteric resection for T2 and T3 rectal cancer situated below 4 cm from the anal verge.

Methods: A total of 62 consecutive patients with very low rectal cancer who underwent ISR from 2001 to 2010 were classified into standard ISR for T2 lesions (Group I, n = 24) and extended ISR for T3 lesions (Group II, n = 38).

Results: The 5-year overall survival rates were 95.8% for group I and 94.7% for group II. The 5-year recurrence-free survival rates were 87.5% for group I and 86.8% for group II. Bowel functions were evaluated at the 12(th) and 24(th) months after ileostomy closure in both groups. The frequency of bowel evacuation was higher in patients who underwent extended ISR than in those who underwent standard ISR at the 12(th) month (p < 0.05). However, at the 24(th) month, the frequencies decreased in both groups, exhibiting no significant difference. In the comparison based on the Kirwan classification, group I showed better continence status than group II but no significant difference. The Wexner scores of both groups revealed that the average score was 7.33 ± 2.8 in group I and 8.18 ± 2.9 in group II at the 12(th) month, and at the 24(th) month, the average score was 5.21 ± 1.7 in group I and 5.82 ± 1.9 in group II. There were no statistically significant differences between the two groups.

Conclusions: Extended ISR with quadrant resection of the upper external sphincter achieved good post-operative continence status, OS and RFS. Extended ISR can thus be an alternative to abdominoperineal resection for very low rectal cancer without compromising the chance of cure and improving quality of life.

No MeSH data available.


Related in: MedlinePlus

Macroscopic finding of the comparison between T2 and T3 tumor. a standard ISR has enough distal and lateral surgical margins in case of T2 tumor. b it is often difficult to ensure a safe resection margin in case of T3 tumor. The resected specimen of extended ISR in T3 tumor shows enough surgical margin included upper part of ES. IS internal sphincter. ES external sphincter
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Fig2: Macroscopic finding of the comparison between T2 and T3 tumor. a standard ISR has enough distal and lateral surgical margins in case of T2 tumor. b it is often difficult to ensure a safe resection margin in case of T3 tumor. The resected specimen of extended ISR in T3 tumor shows enough surgical margin included upper part of ES. IS internal sphincter. ES external sphincter

Mentions: After pelvic dissection with an abdominal approach, intersphincteric resection was performed by perineal approach. For T2 (Group I) lesions, standard ISR was performed. After an incision was placed on the intersphincteric groove level, the gap between the internal and external sphincters was incised and dissection continued along the levator ani in the intersphincteric plane to connect with the pelvic dissection from the abdominal approach. In this process, the intersphincteric plane was dissected while the pelvis was illuminated from the abdomen (Fig. 1a). For the patient with T3 (Group II) lesions, extended ISR was performed. To ensure the safe radial resection margin after dissecting the anal sphincter plane, the deep part of the external sphincter was incised and removed, superficial part and subcutaneous part was preserved at least (Fig. 1b). Macroscopic findings of the resected specimen in group I and II are shown in Fig. 2.Fig. 1


Long-term results of extended intersphincteric resection for very low rectal cancer: a retrospective study.

Kim HS, Ko S, Oh NG - BMC Surg (2016)

Macroscopic finding of the comparison between T2 and T3 tumor. a standard ISR has enough distal and lateral surgical margins in case of T2 tumor. b it is often difficult to ensure a safe resection margin in case of T3 tumor. The resected specimen of extended ISR in T3 tumor shows enough surgical margin included upper part of ES. IS internal sphincter. ES external sphincter
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4835892&req=5

Fig2: Macroscopic finding of the comparison between T2 and T3 tumor. a standard ISR has enough distal and lateral surgical margins in case of T2 tumor. b it is often difficult to ensure a safe resection margin in case of T3 tumor. The resected specimen of extended ISR in T3 tumor shows enough surgical margin included upper part of ES. IS internal sphincter. ES external sphincter
Mentions: After pelvic dissection with an abdominal approach, intersphincteric resection was performed by perineal approach. For T2 (Group I) lesions, standard ISR was performed. After an incision was placed on the intersphincteric groove level, the gap between the internal and external sphincters was incised and dissection continued along the levator ani in the intersphincteric plane to connect with the pelvic dissection from the abdominal approach. In this process, the intersphincteric plane was dissected while the pelvis was illuminated from the abdomen (Fig. 1a). For the patient with T3 (Group II) lesions, extended ISR was performed. To ensure the safe radial resection margin after dissecting the anal sphincter plane, the deep part of the external sphincter was incised and removed, superficial part and subcutaneous part was preserved at least (Fig. 1b). Macroscopic findings of the resected specimen in group I and II are shown in Fig. 2.Fig. 1

Bottom Line: However, at the 24(th) month, the frequencies decreased in both groups, exhibiting no significant difference.In the comparison based on the Kirwan classification, group I showed better continence status than group II but no significant difference.There were no statistically significant differences between the two groups.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, 305 Gudeok-Ro, Seo-Gu, Busan, 602-739, South Korea.

ABSTRACT

Background: Intersphincteric resection (ISR) has become an increasingly popular optional surgical tool for the treatment of very low rectal cancer. The purpose of this study was to assess the long-term oncological and functional outcomes of intersphincteric resection for T2 and T3 rectal cancer situated below 4 cm from the anal verge.

Methods: A total of 62 consecutive patients with very low rectal cancer who underwent ISR from 2001 to 2010 were classified into standard ISR for T2 lesions (Group I, n = 24) and extended ISR for T3 lesions (Group II, n = 38).

Results: The 5-year overall survival rates were 95.8% for group I and 94.7% for group II. The 5-year recurrence-free survival rates were 87.5% for group I and 86.8% for group II. Bowel functions were evaluated at the 12(th) and 24(th) months after ileostomy closure in both groups. The frequency of bowel evacuation was higher in patients who underwent extended ISR than in those who underwent standard ISR at the 12(th) month (p < 0.05). However, at the 24(th) month, the frequencies decreased in both groups, exhibiting no significant difference. In the comparison based on the Kirwan classification, group I showed better continence status than group II but no significant difference. The Wexner scores of both groups revealed that the average score was 7.33 ± 2.8 in group I and 8.18 ± 2.9 in group II at the 12(th) month, and at the 24(th) month, the average score was 5.21 ± 1.7 in group I and 5.82 ± 1.9 in group II. There were no statistically significant differences between the two groups.

Conclusions: Extended ISR with quadrant resection of the upper external sphincter achieved good post-operative continence status, OS and RFS. Extended ISR can thus be an alternative to abdominoperineal resection for very low rectal cancer without compromising the chance of cure and improving quality of life.

No MeSH data available.


Related in: MedlinePlus