[Early results of per anus intersphincteric rectal dissection and direct coloanal anastomosis: sphincter-preserving surgery for patients with very low rectal cancer].
OBJECTIVE
To explore the safety and curative effect of per anus intersphincteric rectal dissection and direct coloanal anastomosis (PIDCA) for patients with very low rectal cancer.


METHODS
Nineteen patients were prospectively studied from June 2002 to October 2004. There were 11 males and 8 females, with a median age of 56 (range, 41 - 74) years. Nineteen patients had T(1) to T(4) tumors (T(1), n = 4; T(2), n = 10; T(3), n = 4; T(4), n = 1) located between 3.5 and 5.0 cm above the anal verge.The rectum, including the entire width of the internal analsphincter, was transected circumferentially via the anal route to secure the surgical margin of safety under direct vision and was mobilized proximally as far as possible through the intersphincteric plane. Per anus coloanal anastomosis was performed following transabdominal resection of the rectum.


RESULTS
There was no operative mortality. Of nineteen patients, two (10.5%) had anastomotic leakage. Median follow-up duration was 16 (range, 3 - 29) months. Up to now, one patient developed recurrence (5.3%). Acceptable anal function results were obtained in most patients.


CONCLUSIONS
Curability and anal function was obtained by PIDCA combined with preoperative or postoperative radiotherapy and postoperative chemotherapy. PIDCA is ideal and safe for selected patients with tumor located below 5 cm from the anal verge.
Kan
Yong-feng
YF
Department of Gastrointestinal Surgery, Affiliated Beijing Chaoyang Hospital, the Capital University of Medical Science, Beijing 100020, China. kyf-9999@vip.sina.com
Liu
Jun
J
Gao
Zhi-gang
ZG
Qu
Hao
H
Zheng
Yi
Y
Yi
Bing-qiang
BQ
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000379:methods*; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome