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Intersphincteric Resection and Coloanal Reconstruction

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Rectal Cancer

Abstract

The main goal of surgical treatment of rectal cancer is the complete removal of tumor and regional lymph nodes. Radical resection for low rectal cancer is the mainstay among the treatment modalities and intersphincteric resection (ISR) is considered a relatively new but effective surgical treatment for low rectal cancer. Increasingly, patients who have undergone abdominoperineal resection in the past can be treated with ISR. Furthermore, preoperative chemoradiation therapy induces tumor regression 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. Recent developments in robotic technology provide an enhanced surgical view and ergonomic instrumentation that facilitate fine dissection with effective exposure. Future investigations should be directed in improving functional outcomes after ISR.

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Abbreviations

APR:

Abdominoperineal resection

CRT:

Chemoradiation therapy

CRM:

Circumferential resection margin

CAA:

Coloanal anastomosis

ISR:

Intersphincteric resection

MRI:

Magnetic resonance imaging

3-D:

Three-dimensional

TME:

Total mesorectal excision

TRUS:

Transrectal ultrasonography

uLAR:

Ultralow anterior resection

References

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

    Article  CAS  PubMed  Google Scholar 

  2. Kim NK, Kim YW, Min BS, Lee KY, Sohn SK, Cho CH. Operative safety and oncologic outcomes of anal sphincter-preserving surgery with mesorectal excision for rectal cancer: 931 consecutive patients treated at a single institution. Ann Surg Oncol. 2009;16(4):900–9.

    Article  PubMed  Google Scholar 

  3. Goligher JC, Dukes CE, Bussey HJ. Local recurrences after sphincter saving excisions for carcinoma of the rectum and rectosigmoid. Br J Surg. 1951;39(155):199–211.

    Article  CAS  PubMed  Google Scholar 

  4. Karanjia ND, Schache DJ, North WR, Heald RJ. ‘Close shave’ in anterior resection. Br J Surg. 1990;77(5):510–2.

    Article  CAS  PubMed  Google Scholar 

  5. Shirouzu K, Isomoto H, Kakegawa T. Distal spread of rectal cancer and optimal distal margin of resection for sphincter-preserving surgery. Cancer. 1995;76(3):388–92.

    Article  CAS  PubMed  Google Scholar 

  6. Andreola S, Leo E, Belli F, Lavarino C, Bufalino R, Tomasic G, et al. Distal intramural spread in adenocarcinoma of the lower third of the rectum treated with total rectal resection and coloanal anastomosis. Dis Colon Rectum. 1997;40(1):25–9.

    Article  CAS  PubMed  Google Scholar 

  7. Kim YW, Kim NK, Min BS, Huh H, Kim JS, Kim JY, et al. Factors associated with anastomotic recurrence after total mesorectal excision in rectal cancer patients. J Surg Oncol. 2009;99(1):58–64.

    Article  PubMed  Google Scholar 

  8. Bujko K, Rutkowski A, Chang GJ, Michalski W, Chmielik E, Kusnierz J. Is the 1-cm rule of distal bowel resection margin in rectal cancer based on clinical evidence? A systematic review. Ann Surg Oncol. 2012;19(3):801–8.

    Article  PubMed  Google Scholar 

  9. 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  PubMed  Google Scholar 

  10. Lyttle JA, Parks AG. Intersphincteric excision of the rectum. Br J Surg. 1977;64(6):413–6.

    Article  CAS  PubMed  Google Scholar 

  11. Shafik A. A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. XII. Anorectal mobilization: a new surgical access to rectal lesions. Preliminary report. Am J Surg. 1981;142(5):629–35.

    Article  CAS  PubMed  Google Scholar 

  12. Parks AG, Percy JP. Resection and sutured colo-anal anastomosis for rectal carcinoma. Br J Surg. 1982;69(6):301–4.

    Article  CAS  PubMed  Google Scholar 

  13. Kang J, Hur H, Min BS, Lee KY, Kim NK. Robotic coloanal anastomosis with or without intersphincteric resection for low rectal cancer: starting with the perianal approach followed by robotic procedure. Ann Surg Oncol. 2012;19(1):154–5.

    Article  PubMed  Google Scholar 

  14. 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(9):1168–75.

    Article  CAS  PubMed  Google Scholar 

  15. 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(4):459–66.

    Article  PubMed  Google Scholar 

  16. 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  PubMed  PubMed Central  Google Scholar 

  17. Schiessel R, Novi G, Holzer B, Rosen HR, Renner K, Holbling N, et al. Technique and long-term results of intersphincteric resection for low rectal cancer. Dis Colon Rectum. 2005;48(10):1858–65. discussion 65–7

    Article  PubMed  Google Scholar 

  18. Shirouzu K, Ogata Y, Araki Y, Kishimoto Y, Sato Y. A new ultimate anus-preserving operation for extremely low rectal cancer and for anal canal cancer. Tech Coloproctol. 2003;7(3):203–6.

    Article  CAS  PubMed  Google Scholar 

  19. AlAsari SF, Lim D, Kim NK. Hemi-levator excision to provide greater sphincter preservation in low rectal cancer. Int J Color Dis. 2013;28(12):1727–8.

    Article  Google Scholar 

  20. Cong JC, Chen CS, Zhang H, Qiao L, Liu EQ. Partial longitudinal resection of the anorectum and sphincter for very low rectal adenocarcinoma: a surgical approach to avoid permanent colostomy. Color Dis. 2012;14(6):697–704.

    Article  CAS  Google Scholar 

  21. Shelygin YA, Vorobiev GI, Pikunov DY, Markova EV, Djhanaev YA, Fomenko OY. Intersphincteric resection with partial removal of external anal sphincter for low rectal cancer. Acta chir Lugosl. 2008;55(3):45–53.

    Article  CAS  Google Scholar 

  22. Fucini C, Elbetti C, Petrolo A, Casella D. Excision of the levator muscles with external sphincter preservation in the treatment of selected low T4 rectal cancers. Dis Colon Rectum. 2002;45(12):1697–705.

    Article  PubMed  Google Scholar 

  23. 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(10):1272–7.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  25. Kim YW, Kim NK, Min BS, Kim H, Pyo J, Kim MJ, et al. A prospective comparison study for predicting circumferential resection margin between preoperative MRI and whole mount sections in mid-rectal cancer: significance of different scan planes. Eur J Surg Oncol. 2008;34(6):648–54.

    Article  CAS  PubMed  Google Scholar 

  26. Chang GJ, You YN, Park IJ, Kaur H, CY H, Rodriguez-Bigas MA, et al. Pretreatment high-resolution rectal MRI and treatment response to neoadjuvant chemoradiation. Dis Colon Rectum. 2012;55(4):371–7.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Dewhurst CE, Mortele KJ. Magnetic resonance imaging of rectal cancer. Radiol Clin N Am. 2013;51(1):121–31.

    Article  PubMed  Google Scholar 

  28. Brown G, Kirkham A, Williams GT, Bourne M, Radcliffe AG, Sayman J, et al. High-resolution MRI of the anatomy important in total mesorectal excision of the rectum. Am J Roentgenol. 2004;182(2):431–9.

    Article  Google Scholar 

  29. MERCURY Study Group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ. 2006;333(7572):779.

    Article  PubMed Central  Google Scholar 

  30. Shihab OC, Moran BJ, Heald RJ, Quirke P, Brown G. MRI staging of low rectal cancer. Eur Radiol. 2009;19(3):643–50.

    Article  PubMed  Google Scholar 

  31. van der Paardt MP, Zagers MB, Beets-Tan RG, Stoker J, Bipat S. Patients who undergo preoperative chemoradiotherapy for locally advanced rectal cancer restaged by using diagnostic MR imaging: a systematic review and meta-analysis. Radiology. 2013;269(1):101–12.

    Article  PubMed  Google Scholar 

  32. Kim NK, Kim MJ, Yun SH, Sohn SK, Min JS. Comparative study of transrectal ultrasonography, pelvic computerized tomography, and magnetic resonance imaging in preoperative staging of rectal cancer. Dis Colon Rectum. 1999;42(6):770–5.

    Article  CAS  PubMed  Google Scholar 

  33. Katsura Y, Yamada K, Ishizawa T, Yoshinaka H, Shimazu H. Endorectal ultrasonography for the assessment of wall invasion and lymph node metastasis in rectal cancer. Dis Colon Rectum. 1992;35(4):362–8.

    Article  CAS  PubMed  Google Scholar 

  34. Hunerbein M, Pegios W, Rau B, Vogl TJ, Felix R, Schlag PM. Prospective comparison of endorectal ultrasound, three-dimensional endorectal ultrasound, and endorectal MRI in the preoperative evaluation of rectal tumors. Preliminary results. Surg Endosc. 2000;14(11):1005–9.

    Article  CAS  PubMed  Google Scholar 

  35. Ryu JG, Kim YW, Kim NK, Huh H, Min BS, Lee KY, et al. Early experience of three dimensional transrectal ultrasonography: comparison of diagnostic accuracy between two dimensional transrectal ultrasonography, computed tomography and magnetic resonance imaging in rectal cancer patients with preoperative chemoradiation therapy. Korean. J Clin Oncol. 2010;6(2):43–51.

    Google Scholar 

  36. 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  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  38. 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(6):1065–71.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  40. Saito N, Sugito M, Ito M, Kobayashi A, Nishizawa Y, Yoneyama Y, et al. Oncologic outcome of intersphincteric resection for very low rectal cancer. World J Surg. 2009;33(8):1750–6.

    Article  PubMed  Google Scholar 

  41. Krand O, Yalti T, Tellioglu G, Kara M, Berber I, Titiz MI. Use of smooth muscle plasty after intersphincteric rectal resection to replace a partially resected internal anal sphincter: long-term follow-up. Dis Colon Rectum. 2009;52(11):1895–901.

    Article  PubMed  Google Scholar 

  42. Han JG, Wei GH, Gao ZG, Zheng Y, Wang ZJ. Intersphincteric resection with direct coloanal anastomosis for ultralow rectal cancer: the experience of People’s Republic of China. Dis Colon Rectum. 2009;52(5):950–7.

    Article  PubMed  Google Scholar 

  43. Akasu T, Takawa M, Yamamoto S, Ishiguro S, Yamaguchi T, Fujita S, et al. Intersphincteric resection for very low rectal adenocarcinoma: univariate and multivariate analyses of risk factors for recurrence. Ann Surg Oncol. 2008;15(10):2668–76.

    Article  PubMed  Google Scholar 

  44. 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  PubMed  Google Scholar 

  45. 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(6):916–21. discussion 21–2

    Article  PubMed  Google Scholar 

  46. 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(10 Suppl):S13–22.

    Article  PubMed  Google Scholar 

  47. Hohenberger W, Merkel S, Matzel K, Bittorf B, Papadopoulos T, Gohl J. The influence of abdomino-peranal (intersphincteric) resection of lower third rectal carcinoma on the rates of sphincter preservation and locoregional recurrence. Color Dis. 2006;8(1):23–33.

    Article  CAS  Google Scholar 

  48. Chin CC, Yeh CY, Huang WS, Wang JY. Clinical outcome of intersphincteric resection for ultra-low rectal cancer. World J Gastroenterol. 2006;12(4):640–3.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Vorobiev GI, Odaryuk TS, Tsarkov PV, Talalakin AI, Rybakov EG. 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. Br J Surg. 2004;91(11):1506–12.

    Article  CAS  PubMed  Google Scholar 

  50. 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  PubMed  Google Scholar 

  51. Bannon JP, Marks GJ, Mohiuddin M, Rakinic J, Jian NZ, Nagle D. Radical and local excisional methods of sphincter-sparing surgery after high-dose radiation for cancer of the distal 3 cm of the rectum. Ann Surg Oncol. 1995;2(3):221–7.

    Article  CAS  PubMed  Google Scholar 

  52. 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(4):407–12.

    Article  CAS  PubMed  Google Scholar 

  53. Benson AB 3rd, Bekaii-Saab T, Chan E, Chen YJ, Choti MA, Cooper HS, et al. Rectal cancer. J Natl Compr Cancer Netw. 2012;10(12):1528–64.

    Article  CAS  Google Scholar 

  54. Silberfein EJ, Kattepogu KM, CY H, Skibber JM, Rodriguez-Bigas MA, Feig B, et al. Long-term survival and recurrence outcomes following surgery for distal rectal cancer. Ann Surg Oncol. 2010;17(11):2863–9.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351(17):1731–40.

    Article  CAS  PubMed  Google Scholar 

  56. Garcia-Aguilar J, Hernandez de Anda E, Sirivongs P, Lee SH, Madoff RD, Rothenberger DA. A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision. Dis Colon Rectum. 2003;46(3):298–304.

    Article  PubMed  Google Scholar 

  57. 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(10 Suppl):S43–7.

    Article  CAS  PubMed  Google Scholar 

  58. Watanabe M, Teramoto T, Hasegawa H, Kitajima M. Laparoscopic ultralow anterior resection combined with per anum intersphincteric rectal dissection for lower rectal cancer. Dis Colon Rectum. 2000;43(10 Suppl):S94–7.

    Article  CAS  PubMed  Google Scholar 

  59. Akasu T, Takawa M, Yamamoto S, Yamaguchi T, Fujita S, Moriya Y. Risk factors for anastomotic leakage following intersphincteric resection for very low rectal adenocarcinoma. J Gastrointest Surg. 2010;14(1):104–11.

    Article  PubMed  Google Scholar 

  60. Kim JS, Lee CR, Kim NK, Hur H, Min BS, Ahn JB, et al. Intersphincteric resection and coloanal anstomosis for very low lying rectal cancer. J Korean Surg Soc. 2009;76(1):28–35.

    Article  Google Scholar 

  61. Otto IC, Ito K, Ye C, Hibi K, Kasai Y, Akiyama S, et al. Causes of rectal incontinence after sphincter-preserving operations for rectal cancer. Dis Colon Rectum. 1996;39(12):1423–7.

    Article  CAS  PubMed  Google Scholar 

  62. Williamson ME, Lewis WG, Finan PJ, Miller AS, Holdsworth PJ, Johnston D. Recovery of physiologic and clinical function after low anterior resection of the rectum for carcinoma: myth or reality? Dis Colon Rectum. 1995;38(4):411–8.

    Article  CAS  PubMed  Google Scholar 

  63. Lazorthes F, Fages P, Chiotasso P, Lemozy J, Bloom E. Resection of the rectum with construction of a colonic reservoir and colo-anal anastomosis for carcinoma of the rectum. Br J Surg. 1986;73(2):136–8.

    Article  CAS  PubMed  Google Scholar 

  64. Parc R, Tiret E, Frileux P, Moszkowski E, Loygue J. Resection and colo-anal anastomosis with colonic reservoir for rectal carcinoma. Br J Surg. 1986;73(2):139–41.

    Article  CAS  PubMed  Google Scholar 

  65. Hida J, Yasutomi M, Fujimoto K, Okuno K, Ieda S, Machidera N, et al. Functional outcome after low anterior resection with low anastomosis for rectal cancer using the colonic J-pouch. Prospective randomized study for determination of optimum pouch size. Dis Colon Rectum. 1996;39(9):986–91.

    Article  CAS  PubMed  Google Scholar 

  66. Drake DB, Pemberton JH, Beart RW Jr, Dozois RR, Wolff BG. Coloanal anastomosis in the management of benign and malignant rectal disease. Ann Surg. 1987;206(5):600–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Kusunoki M, Shoji Y, Yanagi H, Hatada T, Fujita S, Sakanoue Y, et al. Function after anoabdominal rectal resection and colonic J pouch–anal anastomosis. Br J Surg. 1991;78(12):1434–8.

    Article  CAS  PubMed  Google Scholar 

  68. Dehni N, Parc R, Church JM. Colonic J-pouch-anal anastomosis for rectal cancer. Dis Colon Rectum. 2003;46(5):667–75.

    Article  PubMed  Google Scholar 

  69. Nicholls RJ, Lubowski DZ, Donaldson DR. Comparison of colonic reservoir and straight colo-anal reconstruction after rectal excision. Br J Surg. 1988;75(4):318–20.

    Article  CAS  PubMed  Google Scholar 

  70. Ho YH, Tan M, Seow-Choen F. Prospective randomized controlled study of clinical function and anorectal physiology after low anterior resection: comparison of straight and colonic J pouch anastomoses. Br J Surg. 1996;83(7):978–80.

    Article  CAS  PubMed  Google Scholar 

  71. Hallbook O, Nystrom PO, Sjodahl R. Physiologic characteristics of straight and colonic J-pouch anastomoses after rectal excision for cancer. Dis Colon Rectum. 1997;40(3):332–8.

    Article  CAS  PubMed  Google Scholar 

  72. Ho YH, Yu S, Ang ES, Seow-Choen F, Sundram F. Small colonic J-pouch improves colonic retention of liquids--randomized, controlled trial with scintigraphy. Dis Colon Rectum. 2002;45(1):76–82.

    Article  PubMed  Google Scholar 

  73. Seow-Choen F. Colonic pouches in the treatment of low rectal cancer. Br J Surg. 1996;83(7):881–2.

    Article  CAS  PubMed  Google Scholar 

  74. Berger A, Tiret E, Parc R, Frileux P, Hannoun L, Nordlinger B, et al. Excision of the rectum with colonic J pouch-anal anastomosis for adenocarcinoma of the low and mid rectum. World J Surg. 1992;16(3):470–7.

    Article  CAS  PubMed  Google Scholar 

  75. Seow-Choen F, Goh HS. Prospective randomized trial comparing J colonic pouch-anal anastomosis and straight coloanal reconstruction. Br J Surg. 1995;82(5):608–10.

    Article  CAS  PubMed  Google Scholar 

  76. Joo JS, Latulippe JF, Alabaz O, Weiss EG, Nogueras JJ, Wexner SD. Long-term functional evaluation of straight coloanal anastomosis and colonic J-pouch: is the functional superiority of colonic J-pouch sustained? Dis Colon Rectum. 1998;41(6):740–6.

    Article  CAS  PubMed  Google Scholar 

  77. Hida J, Yoshifuji T, Tokoro T, Inoue K, Matsuzaki T, Okuno K, et al. Comparison of long-term functional results of colonic J-pouch and straight anastomosis after low anterior resection for rectal cancer: a five-year follow-up. Dis Colon Rectum. 2004;47(10):1578–85.

    Article  PubMed  Google Scholar 

  78. O’Riordain MG, Molloy RG, Gillen P, Horgan A, Kirwan WO. Rectoanal inhibitory reflex following low stapled anterior resection of the rectum. Dis Colon Rectum. 1992;35(9):874–8.

    Article  PubMed  Google Scholar 

  79. Nakahara S, Itoh H, Mibu R, Ikeda S, Oohata Y, Kitano K, et al. Clinical and manometric evaluation of anorectal function following low anterior resection with low anastomotic line using an EEA stapler for rectal cancer. Dis Colon Rectum. 1988;31(10):762–6.

    Article  CAS  PubMed  Google Scholar 

  80. Ho YH, Seow-Choen F, Tan M. Colonic J-pouch function at six months versus straight coloanal anastomosis at two years: randomized controlled trial. World J Surg. 2001;25(7):876–81.

    Article  CAS  PubMed  Google Scholar 

  81. Harris GJ, Lavery IC, Fazio VW. Function of a colonic J pouch continues to improve with time. Br J Surg. 2001;88(12):1623–7.

    Article  CAS  PubMed  Google Scholar 

  82. Z’Graggen K, Maurer CA, Mettler D, Stoupis C, Wildi S, Buchler MW. A novel colon pouch and its comparison with a straight coloanal and colon J-pouch--anal anastomosis: preliminary results in pigs. Surgery. 1999;125(1):105–12.

    Article  PubMed  Google Scholar 

  83. Maurer CA, Z'Graggen K, Zimmermann W, Hani HJ, Mettler D, Buchler MW. Experimental study of neorectal physiology after formation of a transverse coloplasty pouch. Br J Surg. 1999;86(11):1451–8.

    Article  CAS  PubMed  Google Scholar 

  84. Fazio VW, Mantyh CR, Hull TL. Colonic “coloplasty”: novel technique to enhance low colorectal or coloanal anastomosis. Dis Colon Rectum. 2000;43(10):1448–50.

    Article  CAS  PubMed  Google Scholar 

  85. Mantyh CR, Hull TL, Fazio VW. Coloplasty in low colorectal anastomosis: manometric and functional comparison with straight and colonic J-pouch anastomosis. Dis Colon Rectum. 2001;44(1):37–42.

    Article  CAS  PubMed  Google Scholar 

  86. Remzi FH, Fazio VW, Gorgun E, Zutshi M, Church JM, Lavery IC, et al. Quality of life, functional outcome, and complications of coloplasty pouch after low anterior resection. Dis Colon Rectum. 2005;48(4):735–43.

    Article  PubMed  Google Scholar 

  87. Baker JW. Low end to side rectosigmoidal anastomosis; description of technic. Arch Surg. 1950;61(1):143–57.

    Article  CAS  PubMed  Google Scholar 

  88. Huber FT, Herter B, Siewert JR. Colonic pouch vs. side-to-end anastomosis in low anterior resection. Dis Colon Rectum. 1999;42(7):896–902.

    Article  CAS  PubMed  Google Scholar 

  89. Machado M, Nygren J, Goldman S, Ljungqvist O. Functional and physiologic assessment of the colonic reservoir or side-to-end anastomosis after low anterior resection for rectal cancer: a two-year follow-up. Dis Colon Rectum. 2005;48(1):29–36.

    Article  PubMed  Google Scholar 

  90. Matthiessen P, Hallbook O, Andersson M, Rutegard J, Sjodahl R. Risk factors for anastomotic leakage after anterior resection of the rectum. Color Dis. 2004;6(6):462–9.

    Article  CAS  Google Scholar 

  91. Kim JC, Kim CW, Yoon YS, Lee HO, Park IJ. Levator-sphincter reinforcement after ultralow anterior resection in patients with low rectal cancer: the surgical method and evaluation of anorectal physiology. Surg Today. 2012;42(6):547–53.

    Article  PubMed  Google Scholar 

  92. Diop M, Parratte B, Tatu L, Vuillier F, Brunelle S, Monnier G. “Mesorectum”: the surgical value of an anatomical approach. Surg Radiol Anat. 2003;25(3–4):290–304.

    Article  CAS  PubMed  Google Scholar 

  93. Kim NK. Anatomic basis of sharp pelvic dissection for curative resection of rectal cancer. Yonsei Med J. 2005;46(6):737–49.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Grigorescu BA, Lazarou G, Olson TR, Downie SA, Powers K, Greston WM, et al. Innervation of the levator ani muscles: description of the nerve branches to the pubococcygeus, iliococcygeus, and puborectalis muscles. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(1):107–16.

    Article  PubMed  Google Scholar 

  95. Lazarou G, Grigorescu BA, Olson TR, Downie SA, Powers K, Mikhail MS. Anatomic variations of the pelvic floor nerves adjacent to the sacrospinous ligament: a female cadaver study. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(5):649–54.

    Article  PubMed  Google Scholar 

  96. Fritsch H, Brenner E, Lienemann A, Ludwikowski B. Anal sphincter complex: reinterpreted morphology and its clinical relevance. Dis Colon Rectum. 2002;45(2):188–94.

    Article  PubMed  Google Scholar 

  97. Fenner DE, Kriegshauser JS, Lee HH, Beart RW, Weaver A, Cornella JL. Anatomic and physiologic measurements of the internal and external anal sphincters in normal females. Obstet Gynecol. 1998;91(3):369–74.

    Article  CAS  PubMed  Google Scholar 

  98. Huebner M, Margulies RU, Fenner DE, Ashton-Miller JA, Bitar KN, DeLancey JO. Age effects on internal anal sphincter thickness and diameter in nulliparous females. Dis Colon Rectum. 2007;50(9):1405–11.

    Article  PubMed  PubMed Central  Google Scholar 

  99. Barleben A, Mills S. Anorectal anatomy and physiology. Surg Clin North Am. 2010;90(1):1–15, Table of Contents.

    Article  PubMed  Google Scholar 

  100. Uchimoto K, Murakami G, Kinugasa Y, Arakawa T, Matsubara A, Nakajima Y. Rectourethralis muscle and pitfalls of anterior perineal dissection in abdominoperineal resection and intersphincteric resection for rectal cancer. Anat Sci Int. 2007;82(1):8–15.

    Article  PubMed  Google Scholar 

  101. Kim JY, Kim NK, Lee KY, Hur H, Min BS, Kim JH. A comparative study of voiding and sexual function after total mesorectal excision with autonomic nerve preservation for rectal cancer: laparoscopic versus robotic surgery. Ann Surg Oncol. 2012;19(8):2485–93.

    Article  PubMed  Google Scholar 

  102. Kinugasa Y, Murakami G, Suzuki D, Sugihara K. Histological identification of fascial structures posterolateral to the rectum. Br J Surg. 2007;94(5):620–6.

    Article  CAS  PubMed  Google Scholar 

  103. Kinugasa Y, Murakami G. The contents of lateral ligaments: is organized connective tissue present? Dis Colon Rectum. 2006;49(8):1243–4. Author reply 4–5

    Article  PubMed  Google Scholar 

  104. Kinugasa Y, Murakami G, Uchimoto K, Takenaka A, Yajima T, Sugihara K. Operating behind Denonvilliers’ fascia for reliable preservation of urogenital autonomic nerves in total mesorectal excision: a histologic study using cadaveric specimens, including a surgical experiment using fresh cadaveric models. Dis Colon Rectum. 2006;49(7):1024–32.

    Article  PubMed  Google Scholar 

  105. Kinugasa Y, Arakawa T, Abe S, Ohtsuka A, Suzuki D, Murakami G, et al. Anatomical reevaluation of the anococcygeal ligament and its surgical relevance. Dis Colon Rectum. 2011;54(2):232–7.

    Article  PubMed  Google Scholar 

  106. Matthiessen P, Hallbook O, Rutegard J, Simert G, Sjodahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. 2007;246(2):207–14.

    Article  PubMed  PubMed Central  Google Scholar 

  107. Park IJ, You YN, Schlette E, Nguyen S, Skibber JM, Rodriguez-Bigas MA, et al. Reverse-hybrid robotic mesorectal excision for rectal cancer. Dis Colon Rectum. 2012;55(2):228–33.

    Article  PubMed  PubMed Central  Google Scholar 

  108. Baek SJ, Al-Asari S, Jeong DH, Hur H, Min BS, Baik SH, et al. Robotic versus laparoscopic coloanal anastomosis with or without intersphincteric resection for rectal cancer. Surg Endosc. 2013;27(11):4157–63.

    Article  PubMed  Google Scholar 

  109. Kim JC, Lim SB, Yoon YS, Park IJ, Kim CW, Kim CN. Completely abdominal intersphincteric resection for lower rectal cancer: feasibility and comparison of robot-assisted and open surgery. Surg Endosc. 2014;28(9):2734–44.

    Article  PubMed  Google Scholar 

  110. Paun BC, Cassie S, MacLean AR, Dixon E, Buie WD. Postoperative complications following surgery for rectal cancer. Ann Surg. 2010;251(5):807–18.

    Article  PubMed  Google Scholar 

  111. Tilney HS, Tekkis PP. Extending the horizons of restorative rectal surgery: intersphincteric resection for low rectal cancer. Color Dis. 2008;10(1):3–15. discussion 15–6

    CAS  Google Scholar 

  112. Saito N, Ito M, Kobayashi A, Nishizawa Y, Kojima M, Nishizawa Y, et al. Long-term outcomes after intersphincteric resection for low-lying rectal cancer. Ann Surg Oncol. 2014;21(11):3608–15.

    Article  PubMed  Google Scholar 

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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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Authors and Affiliations

  1. Department of Surgery, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul, 120-527, South Korea

    Nam Kyu Kim & Min Soo Cho

  2. Wonju Severance Christian Hospital, 20, Ilsan-ro, Wonju-si, Gangwon-do, Republic of Korea

    Young Wan Kim

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  1. Nam Kyu Kim
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  2. Young Wan Kim
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  3. Min Soo Cho
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Correspondence to Nam Kyu Kim .

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Editors and Affiliations

  1. Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA

    George J. Chang

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Kim, N.K., Kim, Y.W., Cho, M.S. (2018). Intersphincteric Resection and Coloanal Reconstruction. In: Chang, G. (eds) Rectal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-16384-0_12

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  • DOI: https://doi.org/10.1007/978-3-319-16384-0_12

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