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  • Title: Intersphincteric resection with direct coloanal anastomosis for ultralow rectal cancer: the experience of People's Republic of China.
    Author: Han JG, Wei GH, Gao ZG, Zheng Y, Wang ZJ.
    Journal: Dis Colon Rectum; 2009 May; 52(5):950-7. PubMed ID: 19502861.
    Abstract:
    PURPOSE: The purpose of this study was to evaluate the oncologic and functional outcomes of intersphincteric resection in ultralow rectal cancer. METHODS: From 2000 to 2007, intersphincteric resection with total mesorectal excision was performed in 40 patients with very low rectal cancer (total intersphincteric resection in 5 patients, partial intersphincteric resection in 23 patients, and partial intersphincteric resection with partial dentate line preservation [modified partial intersphincteric resection] in 12 patients). The preoperative tumor stage was T12N01M0. RESULTS: Morbidity occurred in three patients (anastomotic leakage in one patient, wound infection in two patients), but there was no postoperative mortality. The five-year overall survival rate was 97 percent, and the five-year disease-free survival rate was 86 percent. Patients who underwent a modified partial intersphincteric resection (P = 0.004) or a partial intersphincteric resection (P = 0.008) had significantly better continence than those who underwent total intersphincteric resection, and patients with a diverting stoma had significantly better continence (P = 0.043) than those without a stoma, at 12 months after surgery. CONCLUSIONS: Intersphincteric resection is a safe procedure for sphincter-saving rectal surgery in selected patients with very low rectal tumors. A temporary diverting stoma may be beneficial to improve anal function. Modified partial intersphincteric resection under the precondition of radical resection yielded better anal function and a lower rate of incontinence.
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