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Intersphincteric Resection: Indications and Outcome

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Book cover Comprehensive Rectal Cancer Care

Abstract

Despite advances in the management of rectal cancer, surgery remains the mainstay of treatment with curative intent. The major advance in rectal cancer care was the standardization of surgical technique, total mesorectal excision, along with pathological reporting of the excised specimen that led to reductions in local recurrence and improved survival [1–3]. Abdominoperineal excision of the rectum (APR) was once the only option for low tumors but sphincter-preserving surgery is now commonly performed. Despite these options there exists a wide variability in the proportion of patients with rectal tumors that undergo APR (12–51%) [4–6]. The improvements in neoadjuvant therapy have led to better down staging of tumors and in some cases pathological complete response (pCR) [7]. This allows previously inoperable tumors to undergo surgical management or perform less invasive procedures such as local excision or sphincter-preserving surgery.

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References

  1. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery--the clue to pelvic recurrence? Br J Surg. 1982;69(10):613–6.

    Article  CAS  Google Scholar 

  2. Martling AL, Holm T, Rutqvist LE, Moran BJ, Heald RJ, Cedemark B. Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study Group, Basingstoke Bowel Cancer Research Project. Lancet. 2000;356(9224):93–6.

    Article  CAS  Google Scholar 

  3. Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, O’Callaghan C, Myint AS, Bessell E, Thompson LC, Parmar M, Stephens RJ, Sebag-Montefiore D, Investigators MCN-CCT, Group NCCS. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet. 2009;373(9666):821–8.

    Article  Google Scholar 

  4. 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(3):341–5.

    Article  CAS  Google Scholar 

  5. Ricciardi R, Roberts PL, Read TE, Baxter NN, Marcello PW, Schoetz DJ. Who performs proctectomy for rectal cancer in the United States? Dis Colon Rectum. 2011;54(10):1210–5.

    Article  Google Scholar 

  6. Chau A, Maggiori L, Debove C, Kanso F, Hennequin C, Panis Y. Toward the end of abdominoperineal resection for rectal cancer? An 8-year experience in 189 consecutive patients with low rectal cancer. Ann Surg. 2014;260(5):801–6.

    Article  Google Scholar 

  7. Maas M, Nelemans PJ, Valentini V, Das P, Rodel C, Kuo LJ, Calvo FA, Garcia-Aguilar J, Glynne-Jones R, Haustermans K, Mohiuddin M, Pucciarelli S, Small W Jr, Suarez J, Theodoropoulos G, Biondo S, Beets-Tan RG, Beets GL. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol. 2010;11(9):835–44.

    Article  Google Scholar 

  8. Williams NS, Dixon MF, Johnston D. Reappraisal of the 5 centimetre rule of distal excision for carcinoma of the rectum: a study of distal intramural spread and of patients’ survival. Br J Surg. 1983;70(3):150–4.

    Article  CAS  Google Scholar 

  9. Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van Krieken JH, Leer JW, van de Velde CJ. Dutch Colorectal Cancer G. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345(9):638–46.

    Article  CAS  Google Scholar 

  10. Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R. German Rectal Cancer Study G. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351(17):1731–40.

    Article  CAS  Google Scholar 

  11. Sebag-Montefiore D, Stephens RJ, Steele R, Monson J, Grieve R, Khanna S, Quirke P, Couture J, de Metz C, Myint AS, Bessell E, Griffiths G, Thompson LC, Parmar M. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet. 2009;373(9666):811–20.

    Article  Google Scholar 

  12. Ueno H, Mochizuki H, Hashiguchi Y, Ishikawa K, Fujimoto H, Shinto E, Hase K. Preoperative parameters expanding the indication of sphincter preserving surgery in patients with advanced low rectal cancer. Ann Surg. 2004;239(1):34–42.

    Article  Google Scholar 

  13. Martin ST, Heneghan HM, Winter DC. Systematic review of outcomes after intersphincteric resection for low rectal cancer. Br J Surg. 2012;99(5):603–12.

    Article  CAS  Google Scholar 

  14. Schiessel R, Karner-Hanusch J, Herbst F, Teleky B, Wunderlich M. Intersphincteric resection for low rectal tumours. Br J Surg. 1994;81(9):1376–8.

    Article  CAS  Google Scholar 

  15. 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(3):465–9.

    Article  Google Scholar 

  16. Gaujoux S, Bretagnol F, Au J, Ferron M, Panis Y. Single port access proctectomy with total mesorectal excision and intersphincteric resection with a primary transanal approach. Colorectal Dis. 2011;13(9):e305–7.

    Article  CAS  Google Scholar 

  17. Kohler A, Athanasiadis S, Ommer A, Psarakis E. Long-term results of low anterior resection with intersphincteric anastomosis in carcinoma of the lower one-third of the rectum: analysis of 31 patients. Dis Colon Rectum. 2000;43(6):843–50.

    Article  CAS  Google Scholar 

  18. Sharma A, Sharp DM, Walker LG, Monson JR. Predictors of early postoperative quality of life after elective resection for colorectal cancer. Ann Surg Oncol. 2007;14(12):3435–42.

    Article  CAS  Google Scholar 

  19. Sideris L, Zenasni F, Vernerey D, Dauchy S, Lasser P, Pignon JP, Elias D, Di Palma M, Pocard M. Quality of life of patients operated on for low rectal cancer: impact of the type of surgery and patients’ characteristics. Dis Colon Rectum. 2005;48(12):2180–91.

    Article  Google Scholar 

  20. Holzer B, Matzel K, Schiedeck T, Christiansen J, Christensen P, Rius J, Richter P, Lehur PA, Masin A, Kuzu MA, Hussein A, Oresland T, Roche B, Rosen HR. Study Group for Quality of Life in Rectal C. Do geographic and educational factors influence the quality of life in rectal cancer patients with a permanent colostomy? Dis Colon Rectum. 2005;48(12):2209–16.

    Article  Google Scholar 

  21. Iqbal F, Zaman S, Karandikar S, Hendrickse C, Bowley DM. Engaging with faith councils to develop stoma-specific Fatawas: a novel approach to the healthcare needs of Muslim colorectal patients. J Relig Health. 2016;55(3):803–11.

    Google Scholar 

  22. Iqbal F, Batool Z, Varma S, Bowley D, Vaizey C. A survey to assess knowledge among international colorectal clinicians and enterostomal therapy nurses about stoma-related faith needs of Muslim patients. Ostomy Wound Manage. 2014;60(5):28–37.

    PubMed  Google Scholar 

  23. Washington MK, Berlin J, Branton P, Burgart LJ, Carter DK, Fitzgibbons PL, Halling K, Frankel W, Jessup J, Kakar S, Minsky B, Nakhleh R, Compton CC. Members of the Cancer Committee CoAP. Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum. Arch Pathol Lab Med. 2009;133(10):1539–51.

    PubMed  PubMed Central  Google Scholar 

  24. Weiser MR, Quah HM, Shia J, Guillem JG, Paty PB, Temple LK, Goodman KA, Minsky BD, Wong WD. Sphincter preservation in low rectal cancer is facilitated by preoperative chemoradiation and intersphincteric dissection. Ann Surg. 2009;249(2):236–42.

    Article  Google Scholar 

  25. Rullier E, Denost Q, Vendrely V, Rullier A, Laurent C. Low rectal cancer: classification and standardization of surgery. Dis Colon Rectum. 2013;56(5):560–7.

    Article  Google Scholar 

  26. Laforest A, Bretagnol F, Mouazan AS, Maggiori L, Ferron M, Panis Y. Functional disorders after rectal cancer resection: does a rehabilitation programme improve anal continence and quality of life? Colorectal Dis. 2012;14(10):1231–7.

    Article  CAS  Google Scholar 

  27. Bretagnol F, Troubat H, Laurent C, Zerbib F, Saric J, Rullier E. Long-term functional results after sphincter-saving resection for rectal cancer. Gastroenterol Clin Biol. 2004;28(2):155–9.

    Article  Google Scholar 

  28. Canda AE, Terzi C, Gorken IB, Oztop I, Sokmen S, Fuzun M. Effects of preoperative chemoradiotherapy on anal sphincter functions and quality of life in rectal cancer patients. Int J Color Dis. 2010;25(2):197–204.

    Article  Google Scholar 

  29. Gervaz P, Rotholtz N, Wexner SD, You SY, Saigusa N, Kaplan E, Secic M, Weiss EG, Nogueras JJ, Belin B. Colonic J-pouch function in rectal cancer patients: impact of adjuvant chemoradiotherapy. Dis Colon Rectum. 2001;44(11):1667–75.

    Article  CAS  Google Scholar 

  30. Whistance RN, Forsythe RO, McNair AG, Brookes ST, Avery KN, Pullyblank AM, Sylvester PA, Jayne DG, Jones JE, Brown J, Coleman MG, Dutton SJ, Hackett R, Huxtable R, Kennedy RH, Morton D, Oliver A, Russell A, Thomas MG, Blazeby JM, Core O. iNformation SiSSCCWG. A systematic review of outcome reporting in colorectal cancer surgery. Colorectal Dis. 2013;15(10):e548–60.

    Article  CAS  Google Scholar 

  31. Dwan K, Altman DG, Arnaiz JA, Bloom J, Chan AW, Cronin E, Decullier E, Easterbrook PJ, Von Elm E, Gamble C, Ghersi D, Ioannidis JP, Simes J, Williamson PR. Systematic review of the empirical evidence of study publication bias and outcome reporting bias. PLoS One. 2008;3(8):e3081.

    Article  Google Scholar 

  32. Blencowe NS, Strong S, McNair AG, Brookes ST, Crosby T, Griffin SM, Blazeby JM. Reporting of short-term clinical outcomes after esophagectomy: a systematic review. Ann Surg. 2012;255(4):658–66.

    Article  Google Scholar 

  33. Macefield RC, Jacobs M, Korfage IJ, Nicklin J, Whistance RN, Brookes ST, Sprangers MA, Blazeby JM. Developing core outcomes sets: methods for identifying and including patient-reported outcomes (PROs). Trials. 2014;15:49.

    Article  Google Scholar 

  34. Dukes CE. Cancer of the rectum: an analysis of 1000 cases. J Path Bact. 1940;50:527–39.

    Article  Google Scholar 

  35. Westhues H. Die pathologisch-anatomischen Grundlagen der Chirurgie des Rektumkarzinoms. Leipzig: Thieme; 1934.

    Google Scholar 

  36. Goligher JC. The functional results after sphincter-saving resections of the rectum. Ann R Coll Surg Engl. 1951;8(6):421–38.

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Zolciak A, Bujko K, Kepka L, Oledzki J, Rutkowski A, Nowacki MP. Abdominoperineal resection or anterior resection for rectal cancer: patient preferences before and after treatment. Colorectal Dis. 2006;8(7):575–80.

    Article  CAS  Google Scholar 

  38. Heriot AG, Tekkis PP, Constantinides V, Paraskevas P, Nicholls RJ, Darzi A, Fazio VW. Meta-analysis of colonic reservoirs versus straight coloanal anastomosis after anterior resection. Br J Surg. 2006;93(1):19–32.

    Article  CAS  Google Scholar 

  39. Akagi Y, Kinugasa T, Shirouzu K. Intersphincteric resection for very low rectal cancer: a systematic review. Surg Today. 2013;43(8):838–47.

    Article  Google Scholar 

  40. Kuo LJ, Hung CS, Wu CH, Wang W, Tam KW, Liang HH, Chang YJ, Wei PL. Oncological and functional outcomes of intersphincteric resection for low rectal cancer. J Surg Res. 2011;170(1):e93–8.

    Article  Google Scholar 

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Authors and Affiliations

  1. Royal Devon & Exeter Hospital, Exeter, UK

    F. D. McDermott & N. J. Smart

  2. Department of Surgery, St Vincent’s University Hospital, Dublin, Republic of Ireland

    D. C. Winter

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  1. F. D. McDermott
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Editors and Affiliations

  1. University of California, Los Angeles, Los Angeles, CA, USA

    Mary Kwaan

  2. University of Melbourne, Victoria, VIC, Australia

    Andrew Zbar

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McDermott, F.D., Smart, N.J., Winter, D.C. (2019). Intersphincteric Resection: Indications and Outcome. In: Kwaan, M., Zbar, A. (eds) Comprehensive Rectal Cancer Care. Springer, Cham. https://doi.org/10.1007/978-3-319-98902-0_13

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  • DOI: https://doi.org/10.1007/978-3-319-98902-0_13

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-98901-3

  • Online ISBN: 978-3-319-98902-0

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