Research Advancements of Oncological Outcomes Following Intersphincteric Resection and Influencing Factors_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Xiaolong ¹ , DENG Lei ¹ , WANG Xiaodong ² , LI Li ²

1.West China Medical School/West China Hospital MCQ Team, Sichuan University, Chengdu 610041, China;;
2.Center of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Intersphincteric resection; Rectal carcinoma; Oncological outcome; Influencing factor; Radiochemotherapy

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To determine the oncological outcomes following the intersphincteric resection (ISR) for lower rectal cancer and influencing factors.
Methods Reviewed the reports on ISR for lower rectal cancer, and summarized the oncological outcomes and influencing factors. The oncological outcomes included local and distant recurrence rates, postoperative survival, and mortality rates. Tumor indicators, surgical techniques, and perioperative radiochemotherapy were included in the influencing factors.
Results The recurrence, survival, and mortality rates following ISR resemble traditional operations. Higher stages, metastasis, and non-standard operations affect the oncological outcomes significantly. Preoperative radiochemotherapy could improve the efficacy, but probably at the cost of postoperative anal function. Conclusions The oncological outcomes following ISR are acceptable. The careful case selection and rational arrangements of radiochemotherapy will allow better outcomes.

Citation： CHEN Xiaolong ,DENG Lei,WANG Xiaodong,LI Li. Research Advancements of Oncological Outcomes Following Intersphincteric Resection and Influencing Factors. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(5): 515-518. doi: Copy

1.	Saito N, Moriya Y, Shirouzu K, et al. Intersphincteric resection in patients with very low rectal cancer: a review of the Japanese experience[J]. Dis Colon Rectum, 2006; 49(10 Suppl): S13-S22.
2.	Hohenberger W, Merkel S, Matzel K, et al. The influence of abdomino-peranal (intersphincteric) resection of lower third rectal carcinoma on the rates of sphincter preservation and locoregional recurrence[J]. Colorectal Dis, 2006; 8(1): 23-33.
3.	Prete F, Prete FP, Nitti P, et al. Evolution of surgery for cancer of the anorectal junction[J]. Chir Ital, 2007; 59(6): 763-770.
4.	Dai Y, Jiang JB, Bi DS, et al. Preservation of the continence function after intersphincteric resection using a prolapsing technique in the patients with low rectal cancer and its clinical prognosis[J]. Chin Med J (Engl), 2008; 121(20): 2016-2020.
5.	Weiser MR, Quah HM, Shia J, et al. Sphincter preservation in low rectal cancer is facilitated by preoperative chemoradiation and intersphincteric dissection[J]. Ann Surg, 2009; 249(2): 236-242.
6.	Chamlou R, Parc Y, Simon T, et al. Long-term results of intersphincteric resection for low rectal cancer[J]. Ann Surg, 2007; 246(6): 916-922.
7.	Portier G, Ghouti L, Kirzin S, et al. Oncological outcome of ultra-low coloanal anastomosis with and without intersphincteric resection for low rectal adenocarcinoma[J]. Br J Surg, 2007; 94(3): 341-345.
8.	Saito N, Ono M, Sugito M, et al. Early results of intersphincteric resection for patients with very low rectal cancer: an active approach to avoid a permanent colostomy[J]. Dis Colon Rectum, 2004; 47(4): 459-466.
9.	Akasu T, Takawa M, Yamamoto S, et al. Incidence and patterns of recurrence after intersphincteric resection for very low rectal adenocarcinoma[J]. J Am Coll Surg, 2007; 205(5): 642-647.
10.	Yamada K, Ogata S, Saiki Y, et al. Functional results of intersphincteric resection for low rectal cancer[J]. Br J Surg, 2007; 94(10): 1272-1277.
11.	Chin CC, Yeh CY, Huang WS, et al. Clinical outcome of intersphincteric resection for ultra-low rectal cancer[J]. World J Gastroenterol, 2006; 12(4): 640-643.
12.	Akasu T, Takawa M, Yamamoto S, et al. Intersphincteric resection for very low rectal adenocarcinoma: univariate and multivariate analyses of risk factors for recurrence[J]. Ann Surg Oncol, 2008; 15(10): 2668-2676.
13.	Ito M, Saito N, Sugito M, et al. Analysis of clinical factors associated with anal function after intersphincteric resection for very low rectal cancer[J]. Dis Colon Rectum, 2009; 52(1): 64-70.
14.	Shelygin YA, Vorobiev GI, Pikunov DY, et al. Intersphincteric resection with partial removal of external anal sphincter for low rectal cancer[J]. Acta Chir Iugosl, 2008; 55(3): 45-53.
15.	张宏, 陈春生, 丛进春, 等. 括约肌间切除术在超低位直肠癌保肛手术中的应用[J]. 中国普通外科杂志, 2007; 16(9): 835-838.
16.	王振军, 魏广辉. 经肛门切除内括约肌的低位直肠癌保肛术40例临床经验 [J]. 中华外科杂志, 2007; 45（17）: 1173-1175.
17.	Yoo JH, Hasegawa H, Ishii Y, et al. Long-term outcome of per anum intersphincteric rectal dissection with direct coloanal anastomosis for lower rectal cancer[J]. Colorectal Dis, 2005; 7(5): 434-440.
18.	Schiessel R, Novi G, Holzer B, et al. Technique and long-term results of intersphincteric resection for low rectal cancer[J]. Dis Colon Rectum, 2005; 48(10): 1858-1867.
19.	Rullier E, Laurent C, Bretagnol F, et al. Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule[J]. Ann Surg, 2005; 241(3): 465-469.
20.	Vorobiev GI, Odaryuk TS, Tsarkov PV, et al. 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[J]. Br J Surg, 2004; 91(11): 1506-1512.
21.	Tiret E, Poupardin B, McNamara D, et al. Ultralow anterior resection with intersphincteric dissection-what is the limit of safe sphincter preservation?[J]. Colorectal Dis, 2003; 5(5): 454-457.
22.	Salerno GV, Daniels IR, Moran BJ, et al. Magnetic resonance imaging prediction of an involved surgical resection margin in low rectal cancer[J]. Dis Colon Rectum, 2009; 52(4): 632-639.
23.	Moriya Y. Selection and techniques of surgical procedures based on the mode of cancer spread of rectal cancer[J]. Nippon Geka Gakkai Zasshi, 2005; 106(4): 302-305.
24.	Salerno G, Daniels I, Heald RJ, et al. Management and imaging of low rectal carcinoma[J]. Surg Oncol, 2004; 13(2-3): 55-61.
25.	Holzer B, Urban M, Hlbling N, et al. Magnetic resonance imaging predicts sphincter invasion of low rectal cancer and influences selection of operation[J]. Surgery, 2003; 133(6): 656-661.
26.	阚永丰, 刘军, 高志刚, 等. 经肛门括约肌间直肠切除结肠肛管吻合术作为超低位直肠癌保肛术的初步报告[J]. 中华外科杂志, 2005; 43（9）: 573-575.
27.	Wang X, Deng L, Xiao L, et al. Multivariate analysis of the factors affecting the choice of intersphincteric resection in anorectal cancer[J]. Colorectal Dis, 2009; 11(Suppl 2): 44-45.
28.	Schiessel R, Hofmann M, Novi G, et al. Intersphincteric resection of low rectal cancer with coloplasty pouch[J]. Dis Colon Rectum, 2007; 50(5): 670-671.
29.	Orsenigo E, Di Palo S, Vignali A, et al. Laparoscopic intersphincteric resection for low rectal cancer[J]. Surg Oncol, 2007; 16 Suppl 1: S117-S120.
30.	Elshazly WG, Farouk M, Samy M. Preoperative concomitant radiotherapy with oral capecitabine in advanced rectal cancer within 6 cm from anal verge[J]. Int J Colorectal Dis, 2009; 24(4): 401-407.
31.	Bretagnol F, de Calan L. Surgery treatment of rectal cancer[J]. J Chir (Paris), 2006; 143(6): 366-372.
32.	王振军, 梁小波, 杨新庆, 等. 经肛门内外括约肌间切除直肠的直肠癌根治术疗效评价 [J]. 中华胃肠外科杂志, 2006; 9（2）: 111-113.
33.	Rullier E, Laurent C. Advances in surgical treatment of rectal cancer[J]. Minerva Chir, 2003; 58(4): 457-459.
34.	Luppi G, Santantonio M, Bertolini F, et al. Preoperative concomitant radiotherapy and chemotherapy in ultrasound-staged T3 and T4 rectal cancer[J]. Tumori, 2003; 89(2): 152-156.
35.	Matzel KE, Bittorf B, Günther K, et al. Rectal resection with low anastomosis: functional outcome[J]. Colorectal Dis, 2003; 5(5): 458-464.
36.	Marijnen CA, Kapiteijn E, van de Velde CJ, et al. Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial [J]. J Clin Oncol, 2002; 20(3): 817-825.
37.	吴兴桂, 井红民, 蔺桂恒, 等. 经腹腔镜经肛门括约肌间直肠切除结肠肛管吻合术治疗超低位直肠癌13例 [J]. 中国普外基础与临床杂志, 2008; 15（9）: 656-658.
38.	李立. 结直肠癌外科应用技术的规范与创新（十五） [J]. 中国普外基础与临床杂志, 2008; 15（3）: 215-217.

1. Saito N, Moriya Y, Shirouzu K, et al. Intersphincteric resection in patients with very low rectal cancer: a review of the Japanese experience[J]. Dis Colon Rectum, 2006; 49(10 Suppl): S13-S22.
2. Hohenberger W, Merkel S, Matzel K, et al. The influence of abdomino-peranal (intersphincteric) resection of lower third rectal carcinoma on the rates of sphincter preservation and locoregional recurrence[J]. Colorectal Dis, 2006; 8(1): 23-33.
3. Prete F, Prete FP, Nitti P, et al. Evolution of surgery for cancer of the anorectal junction[J]. Chir Ital, 2007; 59(6): 763-770.
4. Dai Y, Jiang JB, Bi DS, et al. Preservation of the continence function after intersphincteric resection using a prolapsing technique in the patients with low rectal cancer and its clinical prognosis[J]. Chin Med J (Engl), 2008; 121(20): 2016-2020.
5. Weiser MR, Quah HM, Shia J, et al. Sphincter preservation in low rectal cancer is facilitated by preoperative chemoradiation and intersphincteric dissection[J]. Ann Surg, 2009; 249(2): 236-242.
6. Chamlou R, Parc Y, Simon T, et al. Long-term results of intersphincteric resection for low rectal cancer[J]. Ann Surg, 2007; 246(6): 916-922.
7. Portier G, Ghouti L, Kirzin S, et al. Oncological outcome of ultra-low coloanal anastomosis with and without intersphincteric resection for low rectal adenocarcinoma[J]. Br J Surg, 2007; 94(3): 341-345.
8. Saito N, Ono M, Sugito M, et al. Early results of intersphincteric resection for patients with very low rectal cancer: an active approach to avoid a permanent colostomy[J]. Dis Colon Rectum, 2004; 47(4): 459-466.
9. Akasu T, Takawa M, Yamamoto S, et al. Incidence and patterns of recurrence after intersphincteric resection for very low rectal adenocarcinoma[J]. J Am Coll Surg, 2007; 205(5): 642-647.
10. Yamada K, Ogata S, Saiki Y, et al. Functional results of intersphincteric resection for low rectal cancer[J]. Br J Surg, 2007; 94(10): 1272-1277.
11. Chin CC, Yeh CY, Huang WS, et al. Clinical outcome of intersphincteric resection for ultra-low rectal cancer[J]. World J Gastroenterol, 2006; 12(4): 640-643.
12. Akasu T, Takawa M, Yamamoto S, et al. Intersphincteric resection for very low rectal adenocarcinoma: univariate and multivariate analyses of risk factors for recurrence[J]. Ann Surg Oncol, 2008; 15(10): 2668-2676.
13. Ito M, Saito N, Sugito M, et al. Analysis of clinical factors associated with anal function after intersphincteric resection for very low rectal cancer[J]. Dis Colon Rectum, 2009; 52(1): 64-70.
14. Shelygin YA, Vorobiev GI, Pikunov DY, et al. Intersphincteric resection with partial removal of external anal sphincter for low rectal cancer[J]. Acta Chir Iugosl, 2008; 55(3): 45-53.
15. 张宏, 陈春生, 丛进春, 等. 括约肌间切除术在超低位直肠癌保肛手术中的应用[J]. 中国普通外科杂志, 2007; 16(9): 835-838.
16. 王振军, 魏广辉. 经肛门切除内括约肌的低位直肠癌保肛术40例临床经验 [J]. 中华外科杂志, 2007; 45（17）: 1173-1175.
17. Yoo JH, Hasegawa H, Ishii Y, et al. Long-term outcome of per anum intersphincteric rectal dissection with direct coloanal anastomosis for lower rectal cancer[J]. Colorectal Dis, 2005; 7(5): 434-440.
18. Schiessel R, Novi G, Holzer B, et al. Technique and long-term results of intersphincteric resection for low rectal cancer[J]. Dis Colon Rectum, 2005; 48(10): 1858-1867.
19. Rullier E, Laurent C, Bretagnol F, et al. Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule[J]. Ann Surg, 2005; 241(3): 465-469.
20. Vorobiev GI, Odaryuk TS, Tsarkov PV, et al. 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[J]. Br J Surg, 2004; 91(11): 1506-1512.
21. Tiret E, Poupardin B, McNamara D, et al. Ultralow anterior resection with intersphincteric dissection-what is the limit of safe sphincter preservation?[J]. Colorectal Dis, 2003; 5(5): 454-457.
22. Salerno GV, Daniels IR, Moran BJ, et al. Magnetic resonance imaging prediction of an involved surgical resection margin in low rectal cancer[J]. Dis Colon Rectum, 2009; 52(4): 632-639.
23. Moriya Y. Selection and techniques of surgical procedures based on the mode of cancer spread of rectal cancer[J]. Nippon Geka Gakkai Zasshi, 2005; 106(4): 302-305.
24. Salerno G, Daniels I, Heald RJ, et al. Management and imaging of low rectal carcinoma[J]. Surg Oncol, 2004; 13(2-3): 55-61.
25. Holzer B, Urban M, Hlbling N, et al. Magnetic resonance imaging predicts sphincter invasion of low rectal cancer and influences selection of operation[J]. Surgery, 2003; 133(6): 656-661.
26. 阚永丰, 刘军, 高志刚, 等. 经肛门括约肌间直肠切除结肠肛管吻合术作为超低位直肠癌保肛术的初步报告[J]. 中华外科杂志, 2005; 43（9）: 573-575.
27. Wang X, Deng L, Xiao L, et al. Multivariate analysis of the factors affecting the choice of intersphincteric resection in anorectal cancer[J]. Colorectal Dis, 2009; 11(Suppl 2): 44-45.
28. Schiessel R, Hofmann M, Novi G, et al. Intersphincteric resection of low rectal cancer with coloplasty pouch[J]. Dis Colon Rectum, 2007; 50(5): 670-671.
29. Orsenigo E, Di Palo S, Vignali A, et al. Laparoscopic intersphincteric resection for low rectal cancer[J]. Surg Oncol, 2007; 16 Suppl 1: S117-S120.
30. Elshazly WG, Farouk M, Samy M. Preoperative concomitant radiotherapy with oral capecitabine in advanced rectal cancer within 6 cm from anal verge[J]. Int J Colorectal Dis, 2009; 24(4): 401-407.
31. Bretagnol F, de Calan L. Surgery treatment of rectal cancer[J]. J Chir (Paris), 2006; 143(6): 366-372.
32. 王振军, 梁小波, 杨新庆, 等. 经肛门内外括约肌间切除直肠的直肠癌根治术疗效评价 [J]. 中华胃肠外科杂志, 2006; 9（2）: 111-113.
33. Rullier E, Laurent C. Advances in surgical treatment of rectal cancer[J]. Minerva Chir, 2003; 58(4): 457-459.
34. Luppi G, Santantonio M, Bertolini F, et al. Preoperative concomitant radiotherapy and chemotherapy in ultrasound-staged T3 and T4 rectal cancer[J]. Tumori, 2003; 89(2): 152-156.
35. Matzel KE, Bittorf B, Günther K, et al. Rectal resection with low anastomosis: functional outcome[J]. Colorectal Dis, 2003; 5(5): 458-464.
36. Marijnen CA, Kapiteijn E, van de Velde CJ, et al. Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial [J]. J Clin Oncol, 2002; 20(3): 817-825.
37. 吴兴桂, 井红民, 蔺桂恒, 等. 经腹腔镜经肛门括约肌间直肠切除结肠肛管吻合术治疗超低位直肠癌13例 [J]. 中国普外基础与临床杂志, 2008; 15（9）: 656-658.
38. 李立. 结直肠癌外科应用技术的规范与创新（十五） [J]. 中国普外基础与临床杂志, 2008; 15（3）: 215-217.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Research Advancements of Oncological Outcomes Following Intersphincteric Resection and Influencing Factors

Abstract Full text Figures/Tables Video References Cited by

Format

Content