Intersphincteric Resection for Rectal Adenocarcinoma Near the Anus

  • Yoshito AkagiEmail author
  • Fumihiko Fujita


Abdominoperineal resection (APR) is commonly performed as radical surgical treatment for low rectal cancer near the anus. To improve the postoperative quality of life (QOL), various sphincter-saving operations have been developed. In particular, intersphincteric resection (ISR) was devised as a new concept of sphincter-saving operation. Current protocols now focus on ISR, which differs from conventional hand-sewn coloanal anastomosis (CAA) after ultimate low anterior resection (LAR). However, the efficacy of ISR remains unclear. In this report, the surgical, oncological, and functional outcomes after ISR are reviewed. This review of the literature was conducted by searching the PubMed online database. Articles focusing on conventional hand-sewn CAA were excluded from this study. The mean mortality rate was <2%, and the mean morbidity rate ranged from 7.5 to 38.3%. The mean local recurrence rate has varied widely from 0 to 22.7%. The mean disease-free survival rate was 69–86 months, and the overall 5-year survival rate was 76–97 months. The functional outcomes have not been excellent but were generally acceptable, although the resting pressure gradually recovered with time. An accurate evaluation of the outcomes is extremely difficult due to the difference among individuals and the absence of any unified appraisal methods. ISR appears to be surgically, oncologically, and functionally acceptable. However, more experience and knowledge of the oncology, anal physiology, and pelvic anatomy are necessary to achieve successful outcomes without complications, and to improve patient survival.


Intersphincteric resection (ISR) Intersphincteric space (ISS) Coloanal anastomosis (CAA) Low rectal cancer 


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© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of SurgeryKurume University School of MedicineKurumeJapan

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