title: Outcomes of ultra-low anterior resection combined with or without intersphincteric resection in lower rectal cancer patients.
abstract: OBJECTIVE
  We evaluated the current practice of ultra-low anterior resection (uLAR) in patients with lower rectal cancer and compared uLARs using mostly transabdominal approach with or without intersphincteric resection (ISR).
  
  
  METHODS
  A total of 624 consecutive lower rectal cancer patients undergoing curative uLAR were prospectively enrolled as ISR+ vs. ISR- groups (329 vs. 295 patients) between 2005 and 2012. The ISR+ group additionally received levator-sphincter reinforcement after distal resection.
  
  
  RESULTS
  The circumferential resection margin (CRM) + rate (≤1 mm) was 2.1 % in the two groups. Postoperative ileus occurred more in the ISR- group than in the ISR+ group (p = 0.02). Substantial erectile dysfunction occurred 1.8 times more frequently in the ISR- group than in the ISR+ group (32 vs. 18.1 %; p = 0.01) among male patients at 2 years postoperatively. The urge to defecate volume and maximal tolerance volume, closely correlated with maximal squeezing pressure and/or mean resting pressure, did not differ between patients with and without chemoradiotherapy until 24 months postoperatively. Nevertheless, the urge to defecate volume was lesser in the ISR- group than in the ISR+ group at 24 months postoperatively (p = 0.022). For 301 patients in which >5 years had elapsed postoperatively, the mean 5-year local recurrence rate was 4.3 %, and the 5-year disease-free and overall survival rates were 78.9 and 92 %, respectively, without differences between the two groups.
  
  
  CONCLUSIONS
  Compared with uLAR without ISR, the transabdominal ISR with levator-sphincter reinforcement provides a safe resection plane with competent CRM, concurrently reduces substantial complications, and marginally promotes recovery of neorectal function.
authors.affiliation: Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea. jckim@amc.seoul.kr.
authors.forename: Jin C
authors.initials: JC
authors.lastname: Kim
authors.affiliation: Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Chang S
authors.initials: CS
authors.lastname: Yu
authors.affiliation: Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Seok-B
authors.initials: SB
authors.lastname: Lim
authors.affiliation: Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Chan W
authors.initials: CW
authors.lastname: Kim
authors.affiliation: Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: In J
authors.initials: IJ
authors.lastname: Park
authors.affiliation: Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Yong S
authors.initials: YS
authors.lastname: Yoon
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003106:Colon / Q000601:surgery*; D018572:Disease-Free Survival; D007172:Erectile Dysfunction / Q000209:etiology; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D045823:Ileus / Q000209:etiology; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D014555:Urination Disorders / Q000209:etiology
keywords: Intersphincteric resection (ISR); Levator-sphincter reinforcement (LSR); Lower rectal cancer; Outcome; Ultra-low anterior resection (uLAR)