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THE PRIMARY RESULTS OF INTERSPHINCTERIC RESECTION IN PATIENTS WITH ULTRALOW RECTAL CANCER
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Abstract
Background: The intersphincteric resection technique (ISR) was developed by Schiessel in the early 1990s as a sphincter-preserving alternative for the Miles’ procedure. Since the first description of this surgical procedure, various institutions published this technique. Objectives: The aim of this study was to evaluate the short-term oncological and functional outcomes in low rectal cancer patients who underwent LISR. Materials and methods: A cross-sectional study included 31 low rectal cancer patients that were treated with laparoscopic ISR with “no stoma” from 03/201903/2021. Perioperative and short-term functional (fecal urgency, defecation frequency and Wexner score) and oncological (cryosection, CRM và resection margin) outcomes were investigated and followed up within 24 months. Results: No mortality occurred within 30 days postoperatively. Early complications: 6.5% of patients had wound infection, 6.5% patients had anastomotic stenosis and 3.2% patients had pelvic abscesses. R0 resection was achieved in 93.5% of the cases, one had local recurrence (ovary) 6 months after surgery and the other one had anastomotic recurrence 12 months after surgery. Mean Wexner incontinence score was 12 and 11 at 6 and 12 months, respectively, the mean number of bowel movements per day after ISR was 4.5. Two patients had liver metastasis after 3 months. Conclusion: Laparoscopic ISR can be a good alternative for APR in the treatment of very low rectal cancer when patients are chosen carefully. Oncological outcomes are good and comparable with those after Miles’ procedure and low anterior resection. Functional outcomes following LISR are suboptimal but acceptable.
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Keywords
Laparoscopic surgery, intersphincteric resection, LISR, rectal cancer, Miles’ procedure, low anterior resection
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