title: Clinical and functional results of laparoscopic intersphincteric resection for ultralow rectal cancer: is there a distinction between the three types of hand-sewn colo-anal anastomosis?
abstract: OBJECTIVE
  The purpose of this study is to compare the clinical and functional outcomes of three types of hand-sewn colo-anal anastomosis (CAA) after laparoscopic intersphincteric resection (Lap-ISR) for patients with ultralow rectal cancer.
  
  
  METHODS
  A total of 79 consecutive patients treated by Lap-ISR for low-lying rectal cancer in an academic medical center from June 2011 to February 2016. According to the distal tumor margin and individualized anal length, the patients underwent three types of hand-sewn CAA including partial-ISR, subtotal-ISR, and total-ISR.
  
  
  RESULTS
  Of the 79 patients, 35.4% required partial-ISR, 43% adopted subtotal-ISR, and 21.5% underwent total-ISR. R0 resection was achieved in 78 patients (98.7%). In addition to distal resection margin, there were no significant differences in clinicopathological parameters and postoperative complications between the three groups. The type of hand-sewn CAA did not influence the 3-year disease-free survival (DFS) or local relapse-free survival (LFS). At 24-months follow-up, in spite of higher incontinence scores in total-ISR group, there were not statistically significant differences in functional outcomes including Wexner score or Kirwan grade between the groups. Nevertheless, patients with chronic anastomotic stricture showed worse anal function than those without the complication.
  
  
  CONCLUSIONS
  The type of hand-sewn CAA after Lap-ISR may not influence oncological and functional outcomes, but chronic stricture deteriorates continence status.
authors.affiliation: Department of Colorectal Surgery, The General Hospital of the PLA Rocket Force, 16 Xingjiekouwai Road, Beijing, 100088, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Colorectal Surgery, The General Hospital of the PLA Rocket Force, 16 Xingjiekouwai Road, Beijing, 100088, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Zhao
authors.affiliation: Department of Colorectal Surgery, The General Hospital of the PLA Rocket Force, 16 Xingjiekouwai Road, Beijing, 100088, China.
authors.forename: Quanlong
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Department of Colorectal Surgery, The General Hospital of the PLA Rocket Force, 16 Xingjiekouwai Road, Beijing, 100088, China.
authors.forename: Shuhui
authors.initials: S
authors.lastname: Yin
authors.affiliation: Department of Colorectal Surgery, The General Hospital of the PLA Rocket Force, 16 Xingjiekouwai Road, Beijing, 100088, China.
authors.forename: Guangzuan
authors.initials: G
authors.lastname: Zhuo
authors.affiliation: Department of Colorectal Surgery, The General Hospital of the PLA Rocket Force, 16 Xingjiekouwai Road, Beijing, 100088, China.
authors.forename: Yujuan
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Colorectal Surgery, The General Hospital of the PLA Rocket Force, 16 Xingjiekouwai Road, Beijing, 100088, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Department of Colorectal Surgery, The General Hospital of the PLA Rocket Force, 16 Xingjiekouwai Road, Beijing, 100088, China. jianhuading75@163.com.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Ding
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D000714:Anastomosis, Surgical; D003106:Colon / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012004:Rectal Neoplasms / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Colo-anal anastomosis; Intersphicteric resection; Laparoscopy; Ultralow rectal cancer