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Intersphincteric Resection and Coloanal Anastomosis

  • Min Soo Cho
  • Nam Kyu Kim
Chapter

Abstract

Radical resection for low rectal cancer is the mainstay among the treatment modalities. Intersphincteric resection (ISR) is considered a relatively new but effective surgical treatment for low-lying rectal tumor. With the advance of treatment modality, patients who have undergone abdominoperineal resection in the past can be treated with ISR. Furthermore, preoperative chemoradiation induces tumor downstaging and facilitates anal sphincter-preserving surgery. To achieve good oncologic outcomes, appropriate patient selection based on magnetic resonance imaging (MRI) is also important because MRI provides accurate information on the extent of tumor invasion and the anal canal structures. On top of all, meticulous surgical technique based on anatomical dissection is essential. Future investigations should be directed in improving functional outcomes after ISR.

Keywords

Rectal neoplasm Intersphincteric resection Coloanal anastomosis Operative technique Operative outcome 

Abbreviations

3-D

Three-dimensional

APR

Abdominoperineal resection

CAA

Coloanal anastomosis

CRM

Circumferential resection margin

CRT

Chemoradiation therapy

ISR

Intersphincteric resection

MRI

Magnetic resonance imaging

TME

Total mesorectal excision

TRUS

Transrectal ultrasonography

uLAR

Ultralow anterior resection

Notes

Acknowledgments

The authors are deeply grateful to Dong-Su Jang, MFA, (Medical Illustrator, Medical Research Support Section, Yonsei University College of Medicine, Seoul, Korea) for his outstanding medical illustrations.

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Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of SurgeryYonsei University College of MedicineSeoulSouth Korea

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