Long-term results of intersphincteric resection for low rectal cancer.
OBJECTIVE
Intersphincteric resection has been performed as an alternative to abdominoperineal resection for low rectal cancer. The purpose of this study was to assess the long-term results after intersphincteric resection in terms of the morbidity, oncologic safety, and defecatory function.


METHODS
Between 1994 and 2006, 107 consecutive patients with low rectal cancer had curative intersphincteric resection, categorized as total, subtotal, or partial resection of the internal anal sphincter.


RESULTS
There were no mortalities. Neorectal mucosal prolapse in patients with total intersphincteric resection and coloanal anastomotic stenosis in patients with subtotal or partial intersphincteric resection were observed as characteristic late complications. The five-year disease-free survival rates classified according to the TNM stage were 100 percent for stage I, 83.5 percent for stage II, and 72.0 percent for stage III cases. The five-year cumulative local recurrence rate after intersphincteric resection was 2.5 percent. Defecatory function, which was evaluated by bowel movement in a 24-hour period, and continence after intersphincteric resection were objectively good. The results of the multivariate analysis revealed that age was the only factor associated with a risk of fecal incontinence.


CONCLUSIONS
Provided strict selection criteria are used, intersphincteric resection may be the optimal sphincter-preserving surgery for low rectal cancer.
Yamada
Kazutaka
K
Coloproctology Center, Takano Hospital, Kumamoto, Japan. k-yamada@magma.jp
Ogata
Shunji
S
Saiki
Yasumitsu
Y
Fukunaga
Mitsuko
M
Tsuji
Yoriyuki
Y
Takano
Masahiro
M
D000230:Adenocarcinoma / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D000704:Analysis of Variance; D003672:Defecation / Q000502:physiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011183:Postoperative Complications; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome