title: Completely abdominal intersphincteric resection for lower rectal cancer: feasibility and comparison of robot-assisted and open surgery.
abstract: BACKGROUND
  Most previous studies of intersphincteric resection (ISR) adopted a two-stage procedure involving abdominal and transanal approaches. We performed completely abdominal ISR via open and a robot-assisted (RA) approaches as treatments for lower rectal cancer (LRC). The RA approach might enable deep dissection and facilitate ISR in patients with restrictive pelvic anatomy.
  
  
  METHODS
  A consecutive cohort of 222 LRC patients who underwent completely abdominal ISR (RA ISR, n = 108; open ISR, n = 114) was enrolled prospectively, and their short-term outcomes were evaluated.
  
  
  RESULTS
  In a multivariate analysis, ISR was performed more frequently in the RA than in the open group (82.6 vs. 67.9 %, p = 0.008). The number of harvested lymph nodes was >12 in both groups. A positive distal resection margin was not observed in either group, and a positive circumferential resection margin was found in one patient in the RA group. Overall morbidity did not differ between the groups. Moderate to severe sexual dysfunction occurred 2.7-fold more frequently in the open group (p = 0.023) among male patients ≤65 years. Mean Wexner's fecal incontinence scores at postoperative months 6 and 12 were greater in the open group than in the RA group (p < 0.05).
  
  
  CONCLUSIONS
  Completely abdominal ISR may be feasible in the treatment of LRC, based on a short-term study. Furthermore, RA ISR had equivalent oncological outcomes and slightly improved functional recovery relative to open ISR.
authors.affiliation: Colorectal Division, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro-43-gil, Songpa-gu, Seoul, 138-736, Korea, jckim@amc.seoul.kr.
authors.forename: Jin C
authors.initials: JC
authors.lastname: Kim
authors.forename: Seok-B
authors.initials: SB
authors.lastname: Lim
authors.forename: Yong S
authors.initials: YS
authors.lastname: Yoon
authors.forename: In J
authors.initials: IJ
authors.lastname: Park
authors.forename: Chan W
authors.initials: CW
authors.lastname: Kim
authors.forename: Chang N
authors.initials: CN
authors.lastname: Kim
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005240:Feasibility Studies; D005242:Fecal Incontinence / Q000453:epidemiology; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000379:methods*