scholarly journals Intersphincteric Resection Pushing the Envelope for Sphincter Preservation

2017 ◽  
Vol 30 (05) ◽  
pp. 368-376 ◽  
Author(s):  
Quentin Denost ◽  
Eric Rullier
Keyword(s):  
Rectal Cancer ◽  
Surgical Treatment ◽  
Sphincter Preservation ◽  
Intersphincteric Resection ◽  
Technical Aspects ◽  
Oncological Outcomes ◽  
Distal Rectal Cancer ◽  
End Colostomy ◽  
Bowel Continuity ◽  
Restoration Of Bowel Continuity

AbstractDuring the last 15 years, a significant evolution has emerged in the surgical treatment of rectal cancer and restoration of bowel continuity has been one of the main goals. For many years the treatment of distal rectal cancer would necessarily require an abdominoperineal resection and end colostomy. The surgical procedure of intersphincteric resection has been proposed to offer sphincter preservation in patients with low rectal cancer and has been legitimized if executed according to adequate oncologic criteria. This article will discuss the best indications, technical aspects, functional, and oncological outcomes of intersphicteric resection in the management of rectal cancer.

scholarly journals Retrospective study of the functional and oncological outcomes of conformal sphincter preservation operation in the treatment of very low rectal cancer

2020 ◽  
Vol 24 (10) ◽  
pp. 1025-1034 ◽  
Author(s):  
G. Sun ◽  
Z. Lou ◽  
H. Zhang ◽  
G. Y. Yu ◽  
K. Zheng ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Rectal Wall ◽  
Anal Verge ◽  
Disease Free Survival ◽  
Sphincter Preservation ◽  
Low Rectal Cancer ◽  
Anal Function ◽  
Oncological Outcomes ◽  
Rectal Cancers ◽  
Very Low Rectal Cancer

Abstract Background Conformal sphincter preservation operation (CSPO) is a new surgical procedure for very low rectal cancers (within 4–5 cm from the anal verge). CSPO preserves more of the dentate line and distal rectal wall and also avoids injuring nerves in the intersphincteric space, resulting in satisfactory anal function after resection. The aim of this study was to analyze the short-term surgical results and long-term oncological and functional outcomes of CSPO. Methods Consecutive patients with very low rectal cancer, who had CSPO between January 2011 and October 2018 at Changhai Hospital, Shanghai were included. Patient demographics, clinicopathological features, oncological outcomes and anal function were analyzed. Results A total of 102 patients (67 men) with a mean age of 56.9 ± 10.8 years were included. The median distance of the tumor from the anal verge was 3 (IQR, 3–4) cm. Thirty-five patients received neoadjuvant chemoradiation (nCRT). The median distal resection margin (DRM) was 0.5 (IQR, 0.3–0.8) cm. One patient had a positive DRM. All circumferential margins were negative. There was no perioperative mortality. The postoperative complication rate was 19.6%. The median duration of follow-up was 28 (IQR, 12–45.5) months. The local recurrence rate was 2% and distant metastasis rate was 10.8%. The 3-year overall survival and disease-free survival rates were 100% and 83.9%, respectively. The mean Wexner incontinence and low anterior resection syndrome scores 12 months after ileostomy reversal were 5.9 ± 4.3, and 29.2 ± 6.9, respectively. Conclusions For patients with very low rectal cancers, fecal continence can be preserved with CSPO without compromising oncological results.

scholarly journals Survival and functional and oncological outcomes following intersphincteric resection for low rectal cancer: short-term results

2018 ◽  
Vol 46 (4) ◽  
pp. 1617-1625 ◽  
Author(s):  
Călin Molnar ◽  
Butiurca Vlad-Olimpiu ◽  
Botoncea Marian ◽  
Togănel Cornelia ◽  
Gurzu Simona
Keyword(s):  
Rectal Cancer ◽  
Survival Rate ◽  
Functional Outcomes ◽  
Intersphincteric Resection ◽  
Low Rectal Cancer ◽  
Study Patient ◽  
Reference Ranges ◽  
Short Term ◽  
Wexner Score ◽  
Oncological Outcomes

Objective This study was performed to evaluate the 1-year survival rate and functional outcomes of 20 patients who underwent intersphincteric resection (ISR) for low rectal cancer. Methods Twenty patients who underwent ISR for low rectal cancer were followed up for 1 year. Complications, functional outcomes objectified by the Wexner score, and oncological outcomes were assessed. Results The short-term survival rate was 100%. The median Wexner score was ≤10 in all patients at 12 months after surgery. Signs of local recurrence were absent, and antigen levels remained within the reference ranges 1 year postoperatively. Conclusions ISR is a feasible alternative in highly selected patients who primarily refuse a colostomy bag and present with type II or III tumors. In the present study, patient-reported continence was satisfactory, and the absence of a colostomy bag increased patients’ quality of life. The oncological outcomes were satisfactory at 1 year postoperatively.

scholarly journals Preoperative Volumetric Modulated Arc Therapy With Simultaneous Integrated Boost for Locally Advanced Distal Rectal Cancer

2019 ◽  
Vol 18 ◽  
pp. 153303381882436 ◽  
Author(s):  
Yongqiang Yang ◽  
Qiteng Liu ◽  
Baoqing Jia ◽  
Xiaohui Du ◽  
Guanghai Dai ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Response Rate ◽  
Volumetric Modulated Arc Therapy ◽  
Sphincter Preservation ◽  
Pathological Response ◽  
Complete Pathological Response ◽  
Distal Rectal Cancer ◽  
Arc Therapy ◽  
Integrated Boost ◽  
Preservation Rate

The aim of this study was to evaluate the safety and clinical efficacy of a combined preoperative regimen consisting of volumetric modulated arc therapy–simultaneous integrated boost and capecitabine chemotherapy for distal rectal cancer. A total of 26 patients with locally advanced distal rectal cancer were enrolled from March 2015 to May 2016. The radiation dose fractionation was 58.75 Gy/25 fractions (2.35 Gy/fraction) for rectal tumor and pelvic lymph node metastasis and 50 Gy/25 fractions for pelvic lymph node stations, accompanied with simultaneous capecitabine chemotherapy. Completion of the simultaneous chemotherapy was ensued by 1 week of rest and then another cycle of induction chemotherapy with capecitabine. A radical rectal cancer surgery was performed 6 to 8 weeks after the simultaneous chemoradiotherapy. The primary end points were the complete pathological response rate and the postoperative sphincter preservation rate. All 26 patients completed the neoadjuvant chemoradiotherapy, among which 25 received surgical treatment. The postoperative complete pathological response rate was as high as 32% (8/25), while the sphincter preservation rate was 60% (15/25), the overall tumor/node (T/N) downstaging rate was 92% (23/25), and the R0 resection rate was 100%. During the chemoradiation, the most common adverse events were grade 1 and 2; grade 3 radiodermatitis occurred in 2 cases but no occurrence of acute adverse events occurred that were grade 4 and above. After the surgery, there was one case of ureteral injury and one case of intestinal obstruction, but no perioperative deaths occurred. In conclusion, the chemoradiation regimen of preoperative volumetric modulated arc therapy-simultaneous integrated boost (VMAT-SIB58.75Gy) and a single cycle of induction chemotherapy with capecitabine for patients with distal rectal cancer is safe and feasible with a satisfactory complete pathological response rate, sphincter preservation rate, and R0 resection rate.

scholarly journals Intersphincteric Resection and Coloanal Anastomosis in Treatment of Distal Rectal Cancer

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Gokhan Cipe ◽  
Mahmut Muslumanoglu ◽  
Erkan Yardimci ◽  
Naim Memmi ◽  
Erhan Aysan
Keyword(s):  
Rectal Cancer ◽  
Abdominoperineal Resection ◽  
Functional Outcomes ◽  
Coloanal Anastomosis ◽  
Intersphincteric Resection ◽  
Distal Rectal Cancer ◽  
Sphincter Saving ◽  
Resection Line ◽  
Alternative Choice

In the treatment of distal rectal cancer, abdominoperineal resection is traditionally performed. However, the recognition of shorter safe distal resection line, intersphincteric resection technique has given a chance of sphincter-saving surgery for patients with distal rectal cancer during last two decades and still is being performed as an alternative choice of abdominoperineal resection. The first aim of this study is to assess the morbidity, mortality, oncological, and functional outcomes of intersphincteric resection. The second aim is to compare outcomes of patients who underwent intersphincteric resection with the outcomes of patients who underwent abdominoperineal resection.

Distal cT2N0 Rectal Cancer: Is There an Alternative to Abdominoperineal Resection?

2005 ◽  
Vol 23 (22) ◽  
pp. 4905-4912 ◽  
Author(s):  
Ramesh Rengan ◽  
Philip Paty ◽  
W. Douglas Wong ◽  
Jose Guillem ◽  
Martin Weiser ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Abdominoperineal Resection ◽  
Pathologic Complete Response ◽  
Rectal Adenocarcinoma ◽  
Sphincter Preservation ◽  
External Beam Radiation ◽  
Cancer Center ◽  
Beam Radiation ◽  
Pelvic Radiation ◽  
Distal Rectal Cancer

Purpose Patients with cT2N0 distal rectal cancer do not require adjuvant therapy. However, when a patient refuses an abdominoperineal resection (APR), is there an alternative? The purpose of this trial is to determine whether preoperative external-beam radiation therapy can increase the rate of sphincter preservation for patients with distal cT2N0 adenocarcinoma of the rectum. Patients and Methods Between April 1988 and October 2003, 27 patients with distal rectal adenocarcinoma staged T2 by clinical and/or endorectal ultrasound who were judged by the operating surgeon to require an APR were treated with preoperative pelvic radiation alone (50.4 Gy). Surgery was performed 4 to 7 weeks later. If pathologic positive pelvic nodes were identified, postoperative adjuvant chemotherapy was recommended. The median follow-up was 55 months (range, 9 to 140 months). Results The pathologic complete response rate was 15% and 78% of patients underwent a sphincter-sparing procedure. The crude incidence of local failure for patients undergoing a sphincter sparing procedure was 10% and the 5-year actuarial incidence was 13%. The actuarial 5-year survival for patients undergoing sphincter preservation was as follows: disease-free, 77%; colostomy-free, 100%; and overall, 85%. Using the Memorial Sloan-Kettering Cancer Center sphincter function score, 54% of those undergoing a sphincter-sparing procedure had good/excellent bowel function at 12 to 24 months after surgery, and 77% had good/excellent function at 24 to 36 months after surgery. Conclusion Our data suggest that for patients with cT2N0 distal rectal cancer who require an APR, preoperative pelvic radiation improves sphincter preservation without an apparent compromise in local control or survival.

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