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  • Title: Resection of the rectum and total excision of the internal anal sphincter with smooth muscle plasty and colonic pouch for treatment of ultralow rectal carcinoma.
    Author: Vorobiev GI, Odaryuk TS, Tsarkov PV, Talalakin AI, Rybakov EG.
    Journal: Br J Surg; 2004 Nov; 91(11):1506-12. PubMed ID: 15455363.
    Abstract:
    BACKGROUND: Intersphincteric resection can provide tumour-free margins for rectal tumours located 0-1 cm above the dentate line. However, the internal anal sphincter (IAS) is partially or totally resected and some degree of anal incontinence may develop. A novel technique of smooth muscle plasty of the IAS and colonic pouch construction is described, along with an assessment of morbidity, oncological results and functional outcome. PATIENTS AND METHODS: Between 1997 and 2002, 27 patients (16 men; median age 55 (range 26-75) years) were operated on for T2-3 N0-1 M0 rectal carcinoma located a median of 1.0 (range 0.5-1.5) cm from the dentate line. Resection of the IAS was performed transanally. A smooth muscle cuff, fashioned from the muscular layer of colon, and a colonic pouch were used for anorectal reconstruction. RESULTS: There were no perioperative deaths. Anastomotic leakage developed in two patients. After a median follow-up of 38 (range 14-66) months no local recurrence was detected. Distant metastases occurred in three patients, two of whom died. Perfect functional outcome was achieved in 22 of 26 patients. At 6 months after surgery the mean(s.d.) resting anal pressure was 49(8) mmHg. CONCLUSION: In selected patients intersphincteric resection does not compromise the oncological result. The suggested anorectal reconstruction may improve the functional outcome.
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