Research Advancements of Oncological Outcomes Following Intersphincteric Resection and Influencing Factors_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Xiaolong ¹ , DENG Lei ¹ , WANG Xiaodong ² , LI Li ²

1.West China Medical School/West China Hospital MCQ Team, Sichuan University, Chengdu 610041, China;;
2.Center of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding?author：

Keywords：

Intersphincteric resection; Rectal carcinoma; Oncological outcome; Influencing factor; Radiochemotherapy

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Objective To determine the oncological outcomes following the intersphincteric resection (ISR) for lower rectal cancer and influencing factors.
Methods Reviewed the reports on ISR for lower rectal cancer, and summarized the oncological outcomes and influencing factors. The oncological outcomes included local and distant recurrence rates, postoperative survival, and mortality rates. Tumor indicators, surgical techniques, and perioperative radiochemotherapy were included in the influencing factors.
Results The recurrence, survival, and mortality rates following ISR resemble traditional operations. Higher stages, metastasis, and non-standard operations affect the oncological outcomes significantly. Preoperative radiochemotherapy could improve the efficacy, but probably at the cost of postoperative anal function. Conclusions The oncological outcomes following ISR are acceptable. The careful case selection and rational arrangements of radiochemotherapy will allow better outcomes.

Citation： CHEN Xiaolong ,DENG Lei,WANG Xiaodong,LI Li. Research Advancements of Oncological Outcomes Following Intersphincteric Resection and Influencing Factors. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(5): 515-518. doi: Copy

1.	Saito N, Moriya Y, Shirouzu K, et al. Intersphincteric resection in patients with very low rectal cancer: a review of the Japanese experience[J]. Dis Colon Rectum, 2006; 49(10 Suppl): S13-S22.
2.	Hohenberger W, Merkel S, Matzel K, et al. The influence of abdomino-peranal (intersphincteric) resection of lower third rectal carcinoma on the rates of sphincter preservation and locoregional recurrence[J]. Colorectal Dis, 2006; 8(1): 23-33.
3.	Prete F, Prete FP, Nitti P, et al. Evolution of surgery for cancer of the anorectal junction[J]. Chir Ital, 2007; 59(6): 763-770.
4.	Dai Y, Jiang JB, Bi DS, et al. Preservation of the continence function after intersphincteric resection using a prolapsing technique in the patients with low rectal cancer and its clinical prognosis[J]. Chin Med J (Engl), 2008; 121(20): 2016-2020.
5.	Weiser MR, Quah HM, Shia J, et al. Sphincter preservation in low rectal cancer is facilitated by preoperative chemoradiation and intersphincteric dissection[J]. Ann Surg, 2009; 249(2): 236-242.
6.	Chamlou R, Parc Y, Simon T, et al. Long-term results of intersphincteric resection for low rectal cancer[J]. Ann Surg, 2007; 246(6): 916-922.
7.	Portier G, Ghouti L, Kirzin S, et al. Oncological outcome of ultra-low coloanal anastomosis with and without intersphincteric resection for low rectal adenocarcinoma[J]. Br J Surg, 2007; 94(3): 341-345.
8.	Saito N, Ono M, Sugito M, et al. Early results of intersphincteric resection for patients with very low rectal cancer: an active approach to avoid a permanent colostomy[J]. Dis Colon Rectum, 2004; 47(4): 459-466.
9.	Akasu T, Takawa M, Yamamoto S, et al. Incidence and patterns of recurrence after intersphincteric resection for very low rectal adenocarcinoma[J]. J Am Coll Surg, 2007; 205(5): 642-647.
10.	Yamada K, Ogata S, Saiki Y, et al. Functional results of intersphincteric resection for low rectal cancer[J]. Br J Surg, 2007; 94(10): 1272-1277.
11.	Chin CC, Yeh CY, Huang WS, et al. Clinical outcome of intersphincteric resection for ultra-low rectal cancer[J]. World J Gastroenterol, 2006; 12(4): 640-643.
12.	Akasu T, Takawa M, Yamamoto S, et al. Intersphincteric resection for very low rectal adenocarcinoma: univariate and multivariate analyses of risk factors for recurrence[J]. Ann Surg Oncol, 2008; 15(10): 2668-2676.
13.	Ito M, Saito N, Sugito M, et al. Analysis of clinical factors associated with anal function after intersphincteric resection for very low rectal cancer[J]. Dis Colon Rectum, 2009; 52(1): 64-70.
14.	Shelygin YA, Vorobiev GI, Pikunov DY, et al. Intersphincteric resection with partial removal of external anal sphincter for low rectal cancer[J]. Acta Chir Iugosl, 2008; 55(3): 45-53.
15.	張宏, 陳春生, 叢進春, 等. 括約肌間切除術在超低位直腸癌保肛手術中的應用[J]. 中國普通外科雜志, 2007; 16(9): 835-838.
16.	王振軍, 魏廣輝. 經肛門切除內括約肌的低位直腸癌保肛術40例臨床經驗 [J]. 中華外科雜志, 2007; 45（17）: 1173-1175.
17.	Yoo JH, Hasegawa H, Ishii Y, et al. Long-term outcome of per anum intersphincteric rectal dissection with direct coloanal anastomosis for lower rectal cancer[J]. Colorectal Dis, 2005; 7(5): 434-440.
18.	Schiessel R, Novi G, Holzer B, et al. Technique and long-term results of intersphincteric resection for low rectal cancer[J]. Dis Colon Rectum, 2005; 48(10): 1858-1867.
19.	Rullier E, Laurent C, Bretagnol F, et al. Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule[J]. Ann Surg, 2005; 241(3): 465-469.
20.	Vorobiev GI, Odaryuk TS, Tsarkov PV, et al. Resection of the rectum and total excision of the internal anal sphincter with smooth muscle plasty and colonic pouch for treatment of ultralow rectal carcinoma[J]. Br J Surg, 2004; 91(11): 1506-1512.
21.	Tiret E, Poupardin B, McNamara D, et al. Ultralow anterior resection with intersphincteric dissection-what is the limit of safe sphincter preservation?[J]. Colorectal Dis, 2003; 5(5): 454-457.
22.	Salerno GV, Daniels IR, Moran BJ, et al. Magnetic resonance imaging prediction of an involved surgical resection margin in low rectal cancer[J]. Dis Colon Rectum, 2009; 52(4): 632-639.
23.	Moriya Y. Selection and techniques of surgical procedures based on the mode of cancer spread of rectal cancer[J]. Nippon Geka Gakkai Zasshi, 2005; 106(4): 302-305.
24.	Salerno G, Daniels I, Heald RJ, et al. Management and imaging of low rectal carcinoma[J]. Surg Oncol, 2004; 13(2-3): 55-61.
25.	Holzer B, Urban M, Hlbling N, et al. Magnetic resonance imaging predicts sphincter invasion of low rectal cancer and influences selection of operation[J]. Surgery, 2003; 133(6): 656-661.
26.	闞永豐, 劉軍, 高志剛, 等. 經肛門括約肌間直腸切除結腸肛管吻合術作為超低位直腸癌保肛術的初步報告[J]. 中華外科雜志, 2005; 43（9）: 573-575.
27.	Wang X, Deng L, Xiao L, et al. Multivariate analysis of the factors affecting the choice of intersphincteric resection in anorectal cancer[J]. Colorectal Dis, 2009; 11(Suppl 2): 44-45.
28.	Schiessel R, Hofmann M, Novi G, et al. Intersphincteric resection of low rectal cancer with coloplasty pouch[J]. Dis Colon Rectum, 2007; 50(5): 670-671.
29.	Orsenigo E, Di Palo S, Vignali A, et al. Laparoscopic intersphincteric resection for low rectal cancer[J]. Surg Oncol, 2007; 16 Suppl 1: S117-S120.
30.	Elshazly WG, Farouk M, Samy M. Preoperative concomitant radiotherapy with oral capecitabine in advanced rectal cancer within 6 cm from anal verge[J]. Int J Colorectal Dis, 2009; 24(4): 401-407.
31.	Bretagnol F, de Calan L. Surgery treatment of rectal cancer[J]. J Chir (Paris), 2006; 143(6): 366-372.
32.	王振軍, 梁小波, 楊新慶, 等. 經肛門內外括約肌間切除直腸的直腸癌根治術療效評價 [J]. 中華胃腸外科雜志, 2006; 9（2）: 111-113.
33.	Rullier E, Laurent C. Advances in surgical treatment of rectal cancer[J]. Minerva Chir, 2003; 58(4): 457-459.
34.	Luppi G, Santantonio M, Bertolini F, et al. Preoperative concomitant radiotherapy and chemotherapy in ultrasound-staged T3 and T4 rectal cancer[J]. Tumori, 2003; 89(2): 152-156.
35.	Matzel KE, Bittorf B, Günther K, et al. Rectal resection with low anastomosis: functional outcome[J]. Colorectal Dis, 2003; 5(5): 458-464.
36.	Marijnen CA, Kapiteijn E, van de Velde CJ, et al. Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial [J]. J Clin Oncol, 2002; 20(3): 817-825.
37.	吳興桂, 井紅民, 藺桂恒, 等. 經腹腔鏡經肛門括約肌間直腸切除結腸肛管吻合術治療超低位直腸癌13例 [J]. 中國普外基礎與臨床雜志, 2008; 15（9）: 656-658.
38.	李立. 結直腸癌外科應用技術的規范與創新（十五） [J]. 中國普外基礎與臨床雜志, 2008; 15（3）: 215-217.

1. Saito N, Moriya Y, Shirouzu K, et al. Intersphincteric resection in patients with very low rectal cancer: a review of the Japanese experience[J]. Dis Colon Rectum, 2006; 49(10 Suppl): S13-S22.
2. Hohenberger W, Merkel S, Matzel K, et al. The influence of abdomino-peranal (intersphincteric) resection of lower third rectal carcinoma on the rates of sphincter preservation and locoregional recurrence[J]. Colorectal Dis, 2006; 8(1): 23-33.
3. Prete F, Prete FP, Nitti P, et al. Evolution of surgery for cancer of the anorectal junction[J]. Chir Ital, 2007; 59(6): 763-770.
4. Dai Y, Jiang JB, Bi DS, et al. Preservation of the continence function after intersphincteric resection using a prolapsing technique in the patients with low rectal cancer and its clinical prognosis[J]. Chin Med J (Engl), 2008; 121(20): 2016-2020.
5. Weiser MR, Quah HM, Shia J, et al. Sphincter preservation in low rectal cancer is facilitated by preoperative chemoradiation and intersphincteric dissection[J]. Ann Surg, 2009; 249(2): 236-242.
6. Chamlou R, Parc Y, Simon T, et al. Long-term results of intersphincteric resection for low rectal cancer[J]. Ann Surg, 2007; 246(6): 916-922.
7. Portier G, Ghouti L, Kirzin S, et al. Oncological outcome of ultra-low coloanal anastomosis with and without intersphincteric resection for low rectal adenocarcinoma[J]. Br J Surg, 2007; 94(3): 341-345.
8. Saito N, Ono M, Sugito M, et al. Early results of intersphincteric resection for patients with very low rectal cancer: an active approach to avoid a permanent colostomy[J]. Dis Colon Rectum, 2004; 47(4): 459-466.
9. Akasu T, Takawa M, Yamamoto S, et al. Incidence and patterns of recurrence after intersphincteric resection for very low rectal adenocarcinoma[J]. J Am Coll Surg, 2007; 205(5): 642-647.
10. Yamada K, Ogata S, Saiki Y, et al. Functional results of intersphincteric resection for low rectal cancer[J]. Br J Surg, 2007; 94(10): 1272-1277.
11. Chin CC, Yeh CY, Huang WS, et al. Clinical outcome of intersphincteric resection for ultra-low rectal cancer[J]. World J Gastroenterol, 2006; 12(4): 640-643.
12. Akasu T, Takawa M, Yamamoto S, et al. Intersphincteric resection for very low rectal adenocarcinoma: univariate and multivariate analyses of risk factors for recurrence[J]. Ann Surg Oncol, 2008; 15(10): 2668-2676.
13. Ito M, Saito N, Sugito M, et al. Analysis of clinical factors associated with anal function after intersphincteric resection for very low rectal cancer[J]. Dis Colon Rectum, 2009; 52(1): 64-70.
14. Shelygin YA, Vorobiev GI, Pikunov DY, et al. Intersphincteric resection with partial removal of external anal sphincter for low rectal cancer[J]. Acta Chir Iugosl, 2008; 55(3): 45-53.
15. 張宏, 陳春生, 叢進春, 等. 括約肌間切除術在超低位直腸癌保肛手術中的應用[J]. 中國普通外科雜志, 2007; 16(9): 835-838.
16. 王振軍, 魏廣輝. 經肛門切除內括約肌的低位直腸癌保肛術40例臨床經驗 [J]. 中華外科雜志, 2007; 45（17）: 1173-1175.
17. Yoo JH, Hasegawa H, Ishii Y, et al. Long-term outcome of per anum intersphincteric rectal dissection with direct coloanal anastomosis for lower rectal cancer[J]. Colorectal Dis, 2005; 7(5): 434-440.
18. Schiessel R, Novi G, Holzer B, et al. Technique and long-term results of intersphincteric resection for low rectal cancer[J]. Dis Colon Rectum, 2005; 48(10): 1858-1867.
19. Rullier E, Laurent C, Bretagnol F, et al. Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule[J]. Ann Surg, 2005; 241(3): 465-469.
20. Vorobiev GI, Odaryuk TS, Tsarkov PV, et al. Resection of the rectum and total excision of the internal anal sphincter with smooth muscle plasty and colonic pouch for treatment of ultralow rectal carcinoma[J]. Br J Surg, 2004; 91(11): 1506-1512.
21. Tiret E, Poupardin B, McNamara D, et al. Ultralow anterior resection with intersphincteric dissection-what is the limit of safe sphincter preservation?[J]. Colorectal Dis, 2003; 5(5): 454-457.
22. Salerno GV, Daniels IR, Moran BJ, et al. Magnetic resonance imaging prediction of an involved surgical resection margin in low rectal cancer[J]. Dis Colon Rectum, 2009; 52(4): 632-639.
23. Moriya Y. Selection and techniques of surgical procedures based on the mode of cancer spread of rectal cancer[J]. Nippon Geka Gakkai Zasshi, 2005; 106(4): 302-305.
24. Salerno G, Daniels I, Heald RJ, et al. Management and imaging of low rectal carcinoma[J]. Surg Oncol, 2004; 13(2-3): 55-61.
25. Holzer B, Urban M, Hlbling N, et al. Magnetic resonance imaging predicts sphincter invasion of low rectal cancer and influences selection of operation[J]. Surgery, 2003; 133(6): 656-661.
26. 闞永豐, 劉軍, 高志剛, 等. 經肛門括約肌間直腸切除結腸肛管吻合術作為超低位直腸癌保肛術的初步報告[J]. 中華外科雜志, 2005; 43（9）: 573-575.
27. Wang X, Deng L, Xiao L, et al. Multivariate analysis of the factors affecting the choice of intersphincteric resection in anorectal cancer[J]. Colorectal Dis, 2009; 11(Suppl 2): 44-45.
28. Schiessel R, Hofmann M, Novi G, et al. Intersphincteric resection of low rectal cancer with coloplasty pouch[J]. Dis Colon Rectum, 2007; 50(5): 670-671.
29. Orsenigo E, Di Palo S, Vignali A, et al. Laparoscopic intersphincteric resection for low rectal cancer[J]. Surg Oncol, 2007; 16 Suppl 1: S117-S120.
30. Elshazly WG, Farouk M, Samy M. Preoperative concomitant radiotherapy with oral capecitabine in advanced rectal cancer within 6 cm from anal verge[J]. Int J Colorectal Dis, 2009; 24(4): 401-407.
31. Bretagnol F, de Calan L. Surgery treatment of rectal cancer[J]. J Chir (Paris), 2006; 143(6): 366-372.
32. 王振軍, 梁小波, 楊新慶, 等. 經肛門內外括約肌間切除直腸的直腸癌根治術療效評價 [J]. 中華胃腸外科雜志, 2006; 9（2）: 111-113.
33. Rullier E, Laurent C. Advances in surgical treatment of rectal cancer[J]. Minerva Chir, 2003; 58(4): 457-459.
34. Luppi G, Santantonio M, Bertolini F, et al. Preoperative concomitant radiotherapy and chemotherapy in ultrasound-staged T3 and T4 rectal cancer[J]. Tumori, 2003; 89(2): 152-156.
35. Matzel KE, Bittorf B, Günther K, et al. Rectal resection with low anastomosis: functional outcome[J]. Colorectal Dis, 2003; 5(5): 458-464.
36. Marijnen CA, Kapiteijn E, van de Velde CJ, et al. Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial [J]. J Clin Oncol, 2002; 20(3): 817-825.
37. 吳興桂, 井紅民, 藺桂恒, 等. 經腹腔鏡經肛門括約肌間直腸切除結腸肛管吻合術治療超低位直腸癌13例 [J]. 中國普外基礎與臨床雜志, 2008; 15（9）: 656-658.
38. 李立. 結直腸癌外科應用技術的規范與創新（十五） [J]. 中國普外基礎與臨床雜志, 2008; 15（3）: 215-217.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Research Advancements of Oncological Outcomes Following Intersphincteric Resection and Influencing Factors

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