Intersphincteric resection irs is a surgical technique used to preserve sphincter function, mainly cases of low rectal cancer located less than 5 cm from the anal verge 1, 2. Li jen kuo, chin sheng hung, weu wang, ka wai tam, hung chia lee, hung hua liang, yu jia chang, ming te huang, po li. Previously, abdominoperineal resection apr was the only surgical treatment option for lowlying rectal cancer. We report our clinical experience of the lapisr procedure carried out using needlescopic instruments. Tamis the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Intersphincteric resection isr is a feasible, effective, safe and valuable procedure with acceptable oncologic and functional outcomes for sphincter saving approach in selected patients with distal rectal carcinomas. This study aimed to elucidate the oncologic outcomes and clinical factors affecting the longterm survival of patients who underwent preoperative chemoradiotherapy followed by intersphincteric resection for locally advanced rectal cancers. Intersphincteric resection allow sphinctersaving surgery. Pdf in the treatment of distal rectal cancer, abdominoperineal resection is traditionally performed. Advances in surgical technique with the use of either advanced stapling or manual coloanal anastomoses have allowed for achieving continuity. The aim of this study was to compare the shortterm and midterm effects of laparoscopic intersphincteric resection with the conventional open approach for patients with low rectal cancer through a metaanalysis. After isr for low rectal cancer with a diverting stoma ds, the ds was closed. However, the recognition of shorter safe distal resection line, intersphincteric resection technique has given a chance of sphinctersaving surgery for patients with distal rectal cancer during last two decades and still is being performed as an alternative choice of abdominoperineal resection.
The aim of this study was to compare the shortterm and midterm effects of laparoscopic intersphincteric. Intersphincteric resection is the optimal procedure for very low rectal cancer. An intersphincteric resection isr with coloanal anastomosis for low rectal cancers has been adopted as an alternative to abdominoperineal excision ape after the report by schiessel et al. Anorectal complications after robotic intersphincteric. What is the place of intersphincteric resection when. Operation time, blood loss, circumferential resection marginpositive rate. Intersphincteric resection for low rectal cancer case. Listing a study does not mean it has been evaluated by the u. In this multicentre randomized controlled study, hartmanns procedure will be compared with intersphincteric abdominoperineal excision in patients with rectal cancer unsuitable for an anterior resection. Tamis versus open intersphincteric resection after. The purpose of this study was to assess the longterm oncological and functional outcomes of intersphincteric resection for t2 and t3 rectal cancer situated below 4 cm from the anal verge. Lower margin of the tumor is assessed, and proper type of isr partial, subtotal, or total is selected. Pdf intersphincteric resection for low rectal cancer. Although it is not standard procedure, transanal intersphincteric resection isr was introduced and has been increasingly performed as an ultimate surgical treatment for extremely low rectal cancer.
In laparoscopic radical resection for rectal cancer, the inferior mesenteric blood vessels are required to be ligated at the origin for dissection of the third station lymph nodes. Isrtme the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Traditionally, conventional intersphincteric resection requires a combined abdominal and perineal approach and a handsewn coloanal anastomosis procedure, which is difficult to accomplish via the perineal approach. Intersphincteric resection for very low rectal adenocarcinoma takayuki akasu, md colorectal surgery division national cancer center hospital tokyo, japan takayuki akasu, md colorectal surgery division national cancer center hospital tokyo, japan akasu ncch 20081025akasu ncch 20081025 vancouver rectal cancer course ubc rectal cancer update. To assess smooth muscle enfoldment and internal sphincter construction smesc for improvement of. Intersphincteric resection for low rectal tumors springerlink. An overview of this procedure, including indications, oncological and functional results based on current literature, is presented herein. A retrospective outcome analysis of 10 consecutive patients who underwent intersphincteric proctectomy with endcolostomy between february and may was performed.
Pdf intersphincteric resection and coloanal anastomosis in. Robotic intersphincteric resection isr has been introduced for sphincterpreservation in the treatment of low rectal cancer. In order to avoid the definitive colostomy in these patients, the intersphincteric resection ir was first described in the 1980s, and well established in the 1990s by schiessel et al. In recent years, intersphincteric resection for low rectal cancer has been offered and performed in patients as an alternative to abdominoperineal resection. Vancouver rectal cancer course ubc rectal cancer update. Direct url citations appear in the printed text, and links to the digital files are provided in the html and pdf versions of this article on the journals web.
Cancerrelated survival and locoregional recurrence rates were calculated using the kaplanmeier method. Sphincter saving surgery of rectal cancer has made an enormous progress over the last 50 years. Function after intersphincteric resection for low rectal cancer and its influence on quality of life article pdf available in colorectal disease 6. By contrast, intersphincteric resection allows sphincter salvage even in low tumors and is now widely accepted among experts in the field of colorectal surgery. Survival and functional and oncological outcomes following. Perianal procedure for intersphincteric resection isr. Intersphincteric resection isr has been performed since 1994, when schiessel et al. Pdf function after intersphincteric resection for low. Currently, the abdominoperineal resection is still the standard surgical. Laparoscopic intersphincteric resection versus an open.
To assess the influence of anastomotic leakage al they compared symptomatic al with asymptomatic leakage and a matched control group without al after low rectal surgery. From july 2004 to december 2009, patients with rectal cancer below 6 cm from anal verge treated by laparoscopic curative intersphincteric resection and abdominoperineal resection were included in a retrospective comparative study. Pdf the treatment of rectal cancer has evolved from being solely a surgical endeavor to a multidisciplinary practice. In isr, the rectum is mobilized to the levator ani muscle in the plane of total mesorectal excision tme. Review open access laparoscopic intersphincteric resection versus an open approach for low rectal cancer. The book will describe the basics pathology,physiology, radiology as well as the surgical technique and its different modifications. However, a delayedonset rectourethral fistula after intersphincteric resection isr for low rectal cancer is extremely rare. Structures of interest pertinent to the operative anatomy were manually segmented in order to reconstruct the 3d geometries. There have been reports of laparoscopic isr 3, 4, but discussion of the specific techniques used in this laparoscopic surgical procedure have not been sufficient. Laparoscopic local excision and rectoanal anastomosis for.
Longterm results of extended intersphincteric resection. Laparoscopic tme with intersphincteric dissection and coloanal anastomosis in ultralow. Intersphincteric resection of low rectal cancer with coloplasty pouch youtube. The clinical significance of the circumferential resection margin following preoperative pelvic. Longterm results of extended intersphincteric resection for very low. Intersphincteric resection for low rectal cancer the decision to perform sphinctersaving resection is related to the distance between the lower tumor edge and the anal verge in low rectal cancers. Long term outcomes after laparoscopic intersphincteric resection with total mesorectal excision for low rectal cancer.
Laparoscopic radical resection for rectal cancer yang. Smooth muscle enfoldment internal sphincter construction. Longterm results of extended intersphincteric resection for very low rectal cancer. Rectourethral fistula is one of the complications that can occur after prostatectomy in the urologic discipline. On the other hand, the introduction of intersphincteric resection in clinical. Intersphincteric resection is a sphincterpreserving procedure developed with the aim of avoiding the need for a permanent stoma in cases with very low rectal cancer, and was introduced by schiessel et al. Anal functionpreserving subtotal intersphincteric resection partial external sphincteric resection with hybrid 2port handassisted laparoscopic surgery mukais operation for very low stage i rectal cancer. Clinical impact of laparoscopic intersphincteric resection. Isr is a surgical technique to preserve sphincter function that was first described by schiessel et al. Intersphincteric resection for very low rectal cancer. Validation and comparative assessment of low anterior. Intersphincteric resection isr has become an increasingly popular optional surgical tool for the treatment of very low rectal cancer.
Isr of low rectal tumours is a surgical technique extending rectal resection into the intersphincteric space. Laparoscopic anterior and intersphincteric resection of. Laparoscopic intersphincteric resection for low rectal. Pdf despite the technological advances over the last years, the treatment of low rectal cancer extraperitoneal remains as a surgical. An external file that holds a picture, illustration, etc. We report a case of intersphincteric resection in a combined multimodality treatment for low rectal cancer, with good oncologic and functional outcome. Recently, laparoscopic lap intersphincteric resection isr for lowlying rectal cancer is gradually permeating worldwide. Ligation of intersphincteric fistula tract abdominal strictureplasty segmental colectomy include ileocolic resection laparoscopic resections lower anterior resection total straight anastomosis, with colon pouch or coloplasty stapled hand sewn abdominoperineal resection. Laparoscopic intersphincteric resection using needlescopic. A case report masaya mukai1, yasutomo sekido2, hiroshi fukumitsu1, hideki izumi1. However, the usefulness of lapisr after neoadjuvant chemoradiotherapy ncrt has not been clarified.
In the treatment of distal rectal cancer, abdominoperineal resection is traditionally performed. The introduction of intersphincteric resection isr is one of the recent advances in the surgical treatment of lower rectal cancer. However, many patients experience anorectal symptoms and defecatory dysfunction after isr. This paper discusses the method used for a robotic intersphincteric resection and coloanal anastomosis. Pioneers such as hochenegg 1, mandl 2, finsterer 3. Intersphincteric resection pushing the envelope for sphincter. The hypothesis is that intersphincteric abdominoperineal excision provides less pelvic and perineal morbidity. A multidisciplinary team is an invaluable means of assessing and further managing the appropriate, tailored to the case, treatment in the aim of achieving best results. All datasets on which the conclusions of the manuscript rely was provided as additional supporting file. This video edit shows the performance of a laparoscopic low anterior and intersphincteric resection for a rectal cancer after neoadjuvant chemoradiotherapy. Techniques, morbidity, oncologic and functional outcomes ali zedan1, anwar tawfik1, ebrahim aboeleupn1, asmaa salah2, aiat morsy3 1surgical oncology department, south egypt cancer institute, assiut university, egypt.
Short term outcomes of roboticassisted intersphincteric resection for low rectal cancer risr the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Intersphincteric resection and coloanal anastomosis in treatment of distal rectal cancer smooth muscle enfoldment internal sphincter construction after intersphincteric resection for rectal cancer plos one, dec 2019. Surgical technique of intersphincteric resection springerlink. A completely abdominal approach partial intersphincteric resection apisr with laparoscopy can simplify the anastomosis procedure.
Several studies have demonstrated the acceptable outcomes of isr in terms of morbidity, oncologic safety, and postoperative anal functions, and isr has been. Currently, the abdominoperineal resection is still the standard surgical treatment for most rectal lesions within 5 cm from the anal verge with wellknown physical and psychological consequences. Further, we intended to analyze the learning curve for laparoscopic surgery and. This retrospective study aimed to evaluate the feasibility of lapisr after ncrt for locally advanced lowlying rectal cancer. Nowadays, ir is defined as a procedure that can obtain satisfactory free margins removing the internal sphincter partially or completely and maintaining. Intersphincteric resection isr for lowlying rectal cancer is an attractive procedure for preserving anal function. The aim of our study was to assess the morbidity, mortality, and the longterm oncologic and functional results of isr. Four patients had at least one flare of terminal ileitis, resulting in ileocecal resection in two patients. Implication of the low anterior resection syndrome lars. Delayed anastomotic leakage following laparoscopic. The surgical procedure of intersphincteric resection has been proposed to offer sphincter preservation in.
Hartmanns procedure vs abdominoperineal resection with. Digital rectal examination is performed to identify intersphincteric groove, and 0. Surgical treatment for low rectal cancer represents a challenge. Patients with a high risk of anastomotic leakage follow ing low anterior resection and a high subsequent mortal ity risk will benefit from hartmanns operation. Intersphincteric resection and coloanal anastomosis in. The intersphincteric resection for low rectal cancers provides a challenge for open approach and also for laparoscopic method. After approximately 1 year, frequent pneumaturia and right orchitis were observed. Short term outcomes of roboticassisted intersphincteric. Intersphincteric resection isr is the final procedure used to preserve the anal function in very low rectal cancer patients. Clinical outcomes of open versus laparoscopic approach and multidimensional analysis of the learning curve for laparoscopic surgery. A total of 62 consecutive patients with very low rectal cancer who.
Assessment of the low anterior resection syndrome lars and postoperative quality of life was performed and scored by the. Intersphincteric resection, in this selected case of low rectal cancer, represented an efficient surgical treatment, with good functional results and quality of life for the patient. Intersphincteric resection is the optimal procedure for. This modified laparoscopic intersphincteric resection technique is a novel and safe method for local excision of rectal gi stromal. This study therefore aimed to investigate the feasibility of laparoscopic resection for low rectal cancer using intersphincteric resection isr and to assess its shortterm oncological outcomes. Long term outcomes after laparoscopic intersphincteric. The pubmed, embase, cochrane, and ovid databases were searched for eligible studies until march 2017. Intersphincteric resection and coloanal reconstruction. Tamis versus open intersphincteric resection after neoadjuvant concurrent chemoradiotherapy. Laparoscopic versus open approach for intersphincteric. Additional maneuvers to reduce the risk of local tumor cell implantation include closure of the rectal stump, cytocidal washout, and pathological evaluation of the distal margin with frozen section analysis 18. With the spread of laparoscopic surgery to colon cancer, laparoscopic rectal. Lynn, guilherme pagin sao juliao, joaquim jose gama rodrigues.
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