title: Technique and long-term results of intersphincteric resection for low rectal cancer.
abstract: OBJECTIVE
  Intersphincteric resection of low rectal tumors is a surgical technique extending rectal resection into the intersphincteric space. This procedure is performed by a synchronous abdominoperineal approach with mesorectal excision and excision of the entire or part of the internal sphincter. This study was designed to evaluate the long-term results of this method focused on continence function and oncologic results.
  
  
  METHODS
  From 1984 to 2000, a total of 121 patients were operated on. The patients were evaluated prospectively according to a detailed preoperative and postoperative program.
  
  
  RESULTS
  One hundred seventeen patients had rectal cancers, two had dysplastic villous adenomas, and two had carcinoid tumors. Cancers were staged according to the Dukes classification (Stage A in 41 percent, Stage B in 28 percent, and Stage C in 31 percent; median distance from the anal margin, 3 (range, 1-5) cm). Postoperative complications were: one death because of pulmonary embolism, 5.1 percent developed an anastomotic fistula, one patient had a fistula to the bladder requiring reoperation, one patient with ileus needed relaparotomy as well as one for intra-abdominal hemorrhage and a small-bowel fistula. One patient developed a fistula after closing the protective colostomy. Five patients developed late strictures of the coloanal anastomosis. After a median follow-up of 72.86 months, 5.3 percent of patients developed local recurrence. The continence status was satisfactory with 16 patients (13.7 percent) showing continence for solid stool only, and 1 patient (0.8 percent) showing episodes of incontinence. A transient problem was a high stool frequency after closure of the protective stoma.
  
  
  CONCLUSIONS
  Intersphincteric resection is a valuable procedure for sphincter-saving rectal surgery. We showed that this technique has satisfactory long-term results in functional and oncologic respects. An important prerequisite is a careful preoperative evaluation of local tumor spread with rectal magnetic resonance imaging excluding infiltration of the external sphincter.
authors.affiliation: Department of Surgery, Danube Hospital/SMZ-Ost, Vienna, Austria. rudolf.schiessel@wienkav.at
authors.forename: Rudolf
authors.initials: R
authors.lastname: Schiessel
authors.forename: Gabriele
authors.initials: G
authors.lastname: Novi
authors.forename: Brigitte
authors.initials: B
authors.lastname: Holzer
authors.forename: Harald R
authors.initials: HR
authors.lastname: Rosen
authors.forename: Karl
authors.initials: K
authors.lastname: Renner
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Hölbling
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Feil
authors.forename: Michael
authors.initials: M
authors.lastname: Urban
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D018253:Adenoma, Villous / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D002276:Carcinoid Tumor / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D003082:Colectomy / Q000379:methods*; D005242:Fecal Incontinence / Q000517:prevention & control; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D002955:Leucovorin; D005472:Fluorouracil