[Efficacy evaluation of anal intersphincteric resection with direct coloanal anastomosis for T1-2 ultra-low rectal cancer].
OBJECTIVE
To evaluate the oncological and functional outcomes of intersphincteric resection (ISR) in T(1-2) ultra-low rectal cancer.


METHODS
From March 2000 to March 2007, ISR with total mesorectal excision (TME) was performed in 40 patients with very low rectal cancer,among whom total ISR in 5 patients, partial ISR in 23 patients, and partial ISR with partial dentate line preservation (modified partial ISR) in 12 patients. The preoperative tumor staging was T(1-2)N(0-1)M(0).


RESULTS
Morbidity was identified in 3 patients including anastomotic leakage in 1 patient and wound infection in 2 patients, and there was no postoperative mortality. The 5-year overall survival rate was 97%, and 5-year disease-free survival rate was 86%. Both patients with modified partial ISR (P=0.004) and patients with partial ISR (P=0.008) had significantly better continence than those with total ISR, and patients with a diverting stoma had significantly better continence (P=0.043) than those without a stoma at 12 months after surgery.


CONCLUSIONS
ISR is a safe procedure for sphincter-saving rectal surgery in selected patients with very low rectal tumors. A temporary diverting stoma may be beneficial to the improvement of anal function. Modified partial ISR under the precondition of radical resection shows better anal function and lower rate of incontinence.
Han
Jia-gang
JG
Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China. wang3zj@sohu.com.
Wang
Zhen-jun
ZJ
Wei
Guang-hui
GH
Xu
Hui-min
HM
Yi
Bing-qiang
BQ
Ma
Hua-chong
HC
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome