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  • Title: The influence of abdomino-peranal (intersphincteric) resection of lower third rectal carcinoma on the rates of sphincter preservation and locoregional recurrence.
    Author: Hohenberger W, Merkel S, Matzel K, Bittorf B, Papadopoulos T, Göhl J.
    Journal: Colorectal Dis; 2006 Jan; 8(1):23-33. PubMed ID: 16519634.
    Abstract:
    OBJECTIVE: The most extended form of rectal resection, representing the very last option for sphincter preservation is abdomino-peranal intersphincteric resection for tumours of the lower third which otherwise would not be resectable with preservation of the sphincter by an abdominal approach alone. PATIENTS AND METHODS: The data of 476 patients with a carcinoma in the lower third of the rectum who underwent primary treatment for stage I-III disease by low anterior resection, abdomino-peranal (intersphincteric) resection or abdominoperineal excision between 1985 and 2001 were analysed. The time periods 1985-94 and 1995-2001 were compared. RESULTS: The rate of intersphincteric resections increased from 3% in 1985-94 to 27% in 1995-2001 while abdominoperineal excisions decreased. Postoperative complication rate was not increased in intersphincteric resections (25%) while postoperative mortality did not differ between the operative procedures. The overall 5-year-rate of locoregional recurrence decreased from 18% to 16%. In intersphincteric resections 14.2% of the patients treated with radiochemotherapy developed locoregional recurrence, while this rate was 46.5% (7/18) if adjuvant treatment was not administered (P = 0.0200). The cancer-related 5-year survival rate was not altered by intersphincteric resection. CONCLUSION: In carcinomas of the lower third of the rectum, the application of abdomino-peranal intersphincteric resection can reduce the need for rectal excision by 20%. Neo-/adjuvant radiochemotherapy is required to reduce locoregional recurrence to an acceptable level.
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