TITLE:
Intersphincteric Resection Is the Optimal Procedure for Very Low Rectal Cancer: Techniques, Morbidity, Oncologic and Functional Outcomes
AUTHORS:
Ali Zedan, Anwar Tawfik, Ebrahim Aboeleupn, Asmaa Salah, Aiat Morsy
KEYWORDS:
Intersphincteric Resection, ISR, Cancer Rectum, Functional Outcomes, Oncologic Outcomes
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.10 No.5,
May
31,
2019
ABSTRACT: Background: The intersphincteric resection the
most extreme form of a sphincter-preserving alternative for the
abdominoperineal resection. Aim of the Work: We investigated
oncological, functional outcomes and morbidity after ISR. Methods: This
retrospective study included 164
patients who underwent ISR with between 2010 and 2015, Male 56.1%, Female 43.9%, with a
median age was 54.5 years, Median follow-up time was of 48 months, Average surgical
time was 230 min,
Median blood loss was 700 mL and median hospital stay
was nine days. Mean tumour size was34 mm. The surgical procedure
through a laparotomy (72.6%), laparoscopically (27.4%). Neoadjuvant radiotherapy 89.6% {long-course radiotherapy
74.4%, short-course radiotherapy 15.2%}, neoadjuvant chemotherapy 28.7% and
adjuvant chemotherapy 70.1%. Colonic
J-pouch 16.5%, Transverse coloplasty 15.9%, a side-to-end anastomosis 26.8% and straight coloanal anastomosis
40.9%. Partial-ISR 36.6%, subtotal-ISR 37.2%, total-ISR 26.2%, diverting ileostomy 6.7%. Results: Operative mortality 1.2%, morbidity 14.6% (anastomotic leakage 3.7%,
anastomotic stenosis 1.8%, a recto-vaginal fistula 2.4% bowel obstruction 3%, surgical site infection
3%. Respiratory tract infection 1.2%, local 7.9%, distant recurrence 15.2%, 5-year overall 79.8%, disease-free survival 75.8%,
R0 resection 95.1%. Pathologic
complete response 11%. Circumferential margin involvement 2.4%. Median number of lymph nodes 17. Mean distal
margin20 mm,
after 12 months Median Wexner score 6. Incontinence for (flatus 11%, liquid 4.9%, solid
4.3%). Median bowel motions in a 24-h were 3. Faecal urgency 17.7%. Stool fragmentation 18.9%. Difficult evacuation 17.7%, lifestyle alteration 14.6%. Difficulty Feces/flatus discrimination 43.3%. Nocturnal
soiling in 17.1%. Daytime soiling 11%. Pad wearing 23.8%. Anti-diarrhoea medication loperamide 14%. Conclusion: ISR is a feasible surgical
procedure for low rectal cancer. Oncologic and functional, outcomes after are
acceptable.