Evaluation of the frequency and pattern of local recurrence following intersphincteric resection for ultra-low rectal cancer.
BACKGROUND
Abdomino-perineal resection has been the standard treatment for rectal tumors located ≤5cm from the anal verge. Recently, intersphincteric resection became a valid option which preserves the bowel continuity with better functional outcome.


OBJECTIVE
Is to evaluate the oncological and functional outcome alongside the associated surgical morbidity in patients with T1-3 rectal cancer, who underwent intersphincteric resection (ISR).


METHODS
Between the years 2006 and 2011, 55 patients with invasive rectal adenocarcinoma, T1-3 lesions, located 2-5cm from the anal verge underwent ISR with total mesorectal excision. When inevitable, complete. ISR was performed, otherwise partial ISR was done. All T3 patients underwent total meso-rectal excision (TME) while some had lateral lymph node dissection (LND) with concomitant pelvic autonomic nerve preservation (PANP).


RESULTS
Among the 55 patients, 21 (38.1%) patients were T1-2 and 34 (61.9%) patients were T3. The tumor location range was 0-5cm from the anal verge (median 2.3cm). Partial or complete ISR was done for 35 (63.6%) and 20 (36.4%), respectively. Patients were followed for a median of 1.5 years (range 1-4.6 years). The 3 year local recurrence and distant metastasis free rates were 85.2% and 85.6%, respectively. All the 3 local recurrences occurred in T3 patients group, and had positive circumferential resection margins. Overall 3-year disease-free survival was 82.6%; while the overall 3-year survival was 88.7%.


CONCLUSIONS
Intersphincteric resection with TME does not affect the local recurrence or overall survival rate in early rectal cancer T1-2 & 3, with preservation of bowel continuity and better life quality.
Surgical Oncology Department, National Cancer Institute (NCI), Fom-El-Khalig, Cairo, Egypt.
W
W
Abdel-Gawad
Surgical Oncology Department, National Cancer Institute (NCI), Fom-El-Khalig, Cairo, Egypt.
A
A
Zaghloul
Surgical Oncology Department, National Cancer Institute (NCI), Fom-El-Khalig, Cairo, Egypt. Electronic address: ibrahim.fakhr@nci.cu.edu.eg.
I
I
Fakhr
Surgical Pathology Department, National Cancer Institute (NCI), Fom-El-Khalig, Cairo, Egypt.
M
M
Sakr
Radio-Diagnosis Department, National Cancer Institute (NCI), Fom-El-Khalig, Cairo, Egypt.
A
A
Shabana
Radiation Oncology Department, National Cancer Institute (NCI), Fom-El-Khalig, Cairo, Egypt.
M
M
Lotayef
Medical Oncology Department, National Cancer Institute (NCI), Fom-El-Khalig, Cairo, Egypt.
O
O
Mansour
D013505:Digestive System Surgical Procedures; D018572:Disease-Free Survival; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery*
Intersphincteric resection; Local recurrence; Low rectal cancer