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Long-term results of intersphincteric resection for low rectal cancer in Japan

  • Kazutaka YamadaEmail author
  • Yasumitsu Saiki
  • Shota Takano
  • Kazutsugu Iwamoto
  • Masafumi Tanaka
  • Mitsuko Fukunaga
  • Tadaaki Noguchi
  • Yasushi Nakamura
  • Saburo Hisano
  • Kensaku Fukami
  • Daisaku Kuwahara
  • Yoriyuki Tsuji
  • Masahiro Takano
  • Koichiro Usuku
  • Tokunori Ikeda
  • Kenichi Sugihara
Review Article
  • 64 Downloads

Abstract

Intersphincteric resection (ISR) is the ultimate sphincter-preserving procedure for low rectal cancer. A questionnaire about the standardization of ISR was given to 2125 patients who underwent curative ISR for low rectal cancer between 2005 and 2012 at 127 affiliated institutions of the Japanese Society for Cancer of the Colon and Rectum (JSCCR), and the results were compared with the results of a systematic review. The findings revealed that although mortality and morbidity were relatively low and the survival rate after ISR was good, the rates of local recurrence and postoperative fecal incontinence were relatively high. The radicality of ISR was compared with that of abdominoperineal resection and low anterior resection using the propensity score matching prognosis analysis of patients in the JSCCR nationwide registry. The local recurrence rate was significantly higher after ISR, and especially high in patients with T3 (invasion into the external anal sphincter) and T4 disease. These results provide evidence about the factors related to fecal incontinence after ISR. As measures for the standardization of ISR, it is important to reconfirm that ISR is not indicated for patients with cT3 and cT4 disease and those with poor preoperative defecatory function, based on the ISR indication criteria.

Keywords

Low rectal cancer Intersphincteric resection Oncological outcome Defecatory function 

Notes

Compliance with ethical standards

Conflict of interest

Kazutaka Yamada and his co-authors have no conflicts of interest to declare.

References

  1. 1.
    Lyttle JA, Parks AG. Intersphincteric excision of the rectum. Br J Surg. 1977;64:413–6.CrossRefGoogle Scholar
  2. 2.
    Braun J, Treutner KH, Winkeltau G, Heidenreich U, Lerch MM, Schumpelick V. Results of intersphincteric resection of the rectum with direct coloanal anastomosis for rectal carcinoma. Am J Surg. 1992;163:407–12.CrossRefGoogle Scholar
  3. 3.
    Schiessel R, Karner-Hanusch J, Herbst F, Teleky B, Wunderlich M. Intersphincteric resection for low rectal tumours. Br J Surg. 1994;81:1376–8.CrossRefGoogle Scholar
  4. 4.
    Teramoto T, Watanabe M, Kitajima M. Per anum intersphincteric rectal dissection with direct coloanal anastomosis for lower rectal cancer: the ultimate sphincter-preserving operation. Dis Colon Rectum. 1997;40:43-7.CrossRefGoogle Scholar
  5. 5.
    Rullier E, Zerbib F, Laurent C, Bonnel C, Caudry M, Saric J, et al. Intersphincteric resection with excision of internal anal sphincter for conservative treatment of very low rectal cancer. Dis Colon Rectum. 1999;42:1168–75.CrossRefGoogle Scholar
  6. 6.
    Saito N, Ono M, Sugito M, Ito M, Morihiro M, Kosugi C, et al. Early results of intersphincteric resection for patients with very low rectal cancer: an active approach to avoid a permanent colostomy. Dis Colon Rectum. 2004;47:459–66.CrossRefGoogle Scholar
  7. 7.
    Martin ST, Heneghan HM, Winter DC. Systematic review of outcomes after intersphincteric resection for low rectal cancer. Br J Surg. 2012;99:603–12.CrossRefGoogle Scholar
  8. 8.
    Watanabe T, Muro K, Ajioka Y, Hashiguchi Y, Ito Y, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2016 for the treatment of Colorectal Cancer. Int J Clin Oncol. 2018;23:1–34.CrossRefGoogle Scholar
  9. 9.
    Schiessel R, Novi G, Holzer B, Rosen HR, Renner K, Hölbling N, et al. Technique and long-term results of intersphincteric resection for low rectal cancer. Dis Colon Rectum. 2005;48:1858–67.CrossRefGoogle Scholar
  10. 10.
    Rullier E, Laurent C, Bretagnol F, Rullier A, Vendrely V, Zerbib F. Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule. Ann Surg. 2005;241:465–9.CrossRefGoogle Scholar
  11. 11.
    Hohenberger W, Merkel S, Matzel K, Bittorf B, Papadopoulos T, Göhl J. The influence of abdomino-peranal (intersphincteric) resection of lower third rectal carcinoma on the rates of sphincter preservation and locoregional recurrence. Colorectal Dis. 2006;8:23–33.CrossRefGoogle Scholar
  12. 12.
    Saito N, Moriya Y, Shirouzu K, Maeda K, Mochizuki H, Koda K, et al. Intersphincteric resection in patients with very low rectal cancer: a review of the Japanese experience. Dis Colon Rectum. 2006;49:13–22.CrossRefGoogle Scholar
  13. 13.
    Portier G, Ghouti L, Kirzin S, Guimbaud R, Rives M, Lazorthes F. Oncological outcome of ultra-low coloanal anastomosis with and without intersphincteric resection for low rectal adenocarcinoma. Br J Surg. 2007;94:341–5.CrossRefGoogle Scholar
  14. 14.
    Yamada K, Ogata S, Saiki Y, Fukunaga M, Tsuji Y, Takano M. Functional results of intersphincteric resection for low rectal cancer. Br J Surg. 2007;94:1272–7.CrossRefGoogle Scholar
  15. 15.
    Yamada K, Ogata S, Saiki Y, Fukunaga M, Tsuji Y, Takano M. Long-term results of intersphincteric resection for low rectal cancer. Dis Colon Rectum. 2009;52:1065–71.CrossRefGoogle Scholar
  16. 16.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefGoogle Scholar
  17. 17.
    Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36:77–97.CrossRefGoogle Scholar
  18. 18.
    Kirwan WO, Turnbull RB Jr, Fazio VW, Weakley FL. Pullthrough operation with delayed anastomosis for rectal cancer. Br J Surg. 1978;65:695–8.CrossRefGoogle Scholar
  19. 19.
    Watanabe M, Teramoto T, Hasegawa H, Kitajima M. Laparoscopic ultralow anterior resection combined with per anum intersphincteric rectal dissection for low rectal cancer. Dis Colon Rectum. 2000;43:94-7.CrossRefGoogle Scholar
  20. 20.
    Laurent C, Paumet T, Leblanc F, Denost Q, Rullier E. Intersphincteric resection for low rectal cancer: laparoscopic vs open surgery approach. Colorectal Dis. 2012;14:35–43.CrossRefGoogle Scholar
  21. 21.
    Park JS, Choi GS, Jun SH, Hasegawa S, Sakai Y. Laparoscopic versus open intersphincteric resection and coloanal anastomosis for low rectal cancer: intermediate-term oncologic outcomes. Ann Surg. 2011;254:941–6.CrossRefGoogle Scholar
  22. 22.
    Yoo BE, Cho JS, Shin JW, Lee DW, Kwak JM, Kim J, et al. Robotic versus laparoscopic intersphincteric resection for low rectal cancer: comparison of the operative, oncological, and functional outcomes. Ann Surg Oncol. 2015;22:1219–25.CrossRefGoogle Scholar
  23. 23.
    Park JS, Kim NK, Kim SH, Lee KY, Lee KY, Shin JY, et al. Multicentre study of robotic intersphincteric resection for low rectal cancer. Br J Surg. 2015;102:1567–73.CrossRefGoogle Scholar
  24. 24.
    Yamada K, Ogata S, Saiki Y, Fukunaga M, Tanaka M, Tsuji Y, et al. Long-term oncologic results of intersphincteric resection for low rectal cancer. J Clin Surg. 2014;69:276–82 (in Japanese).Google Scholar
  25. 25.
    Yamada K, Ogata S, Saiki Y, Takano S, Iwamoto K, Fukunaga M, et al. Functional results of intersphincteric resection for low rectal cancer. J Jpn Soc Coloproctol. 2016;69:513–20 (in Japanese with English abstract).CrossRefGoogle Scholar
  26. 26.
    Chamlou R, Parc Y, Simon T, Bennis M, Dehni N, Parc R, et al. Long-term results of intersphincteric resection for low rectal cancer. Ann Surg. 2007;246:916–22.CrossRefGoogle Scholar
  27. 27.
    Pollack J, Holm T, Cedermark B, Holmström B, Mellgren A. Long-term effect of preoperative radiation therapy on anorectal function. Dis Colon Rectum. 2006;49:345–52.CrossRefGoogle Scholar
  28. 28.
    Lange MM, den Dulk M, Bossema ER, Maas CP, Peeters KC, Rutten HJ, et al. Risk factors for faecal incontinence after rectal cancer treatment. Br J Surg. 2007;94:1278–84.CrossRefGoogle Scholar
  29. 29.
    Juul T, Ahlberg M, Biondo S, Emmertsen KJ, Espin E, Jimenez LM, et al. International validation of the low anterior resection syndrome score. Ann Surg. 2014;259:728–34.CrossRefGoogle Scholar
  30. 30.
    Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, et al. Fecal incontinence quality of life scale; quality of life instrument for patients with fecal incontinence. Dis Colon Rectum. 2000;43:9–17.CrossRefGoogle Scholar
  31. 31.
    Ho YH, Chiang JM, Tan M, Low JY. Biofeedback therapy for excessive stool frequency and incontinence following anterior resection or total colectomy. Dis Colon Rectum. 1996;39:1289–92.CrossRefGoogle Scholar
  32. 32.
    Dedemadi G, Takano S. Efficacy of bilateral transcutaneous posterior tibial nerve stimulation for fecal incontinence. Perm J. 2018;22:56–9.Google Scholar
  33. 33.
    Pescatori M, Pavesio R, Anastasio G, Daini S. Transanal electrostimulation for fecal incontinence: clinical, psychologic and manometric prospective study. Dis Colon Rectum. 1991;34:540–5.CrossRefGoogle Scholar
  34. 34.
    Ramage L, Qiu S, Kontovounisios C, Tekkis P, Rasheed S, Tan E. A systematic review of sacral nerve stimulation for low anterior resection syndrome. Colorectal Dis. 2015;17:762–71.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Kazutaka Yamada
    • 1
    Email author
  • Yasumitsu Saiki
    • 1
  • Shota Takano
    • 1
  • Kazutsugu Iwamoto
    • 1
  • Masafumi Tanaka
    • 1
  • Mitsuko Fukunaga
    • 1
  • Tadaaki Noguchi
    • 1
  • Yasushi Nakamura
    • 1
  • Saburo Hisano
    • 1
  • Kensaku Fukami
    • 1
  • Daisaku Kuwahara
    • 1
  • Yoriyuki Tsuji
    • 1
  • Masahiro Takano
    • 1
  • Koichiro Usuku
    • 2
  • Tokunori Ikeda
    • 2
  • Kenichi Sugihara
    • 3
  1. 1.Department of SurgeryColoproctology Center Takano HospitalKumamotoJapan
  2. 2.Department of Medical Information Sciences and Administration PlanningKumamoto University HospitalKumamotoJapan
  3. 3.The Japanese Society for Cancer of the Colon and RectumTokyoJapan

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