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Objective To evaluate the long-term therapeutic results of intersphincteric resection (ISR) in the treatment of ultra-low rectal cancer.Methods Sixty cases of ultra-low rectal cancer with the inferior border of the tumor within 5 cm to the edge of anus underwent intersphincteric resection (ISR),and the clinical data were analyzed retrospectively.There were 39 males,21 females and their average age was 55 years old (range from 30 to 77 years old).The inferior border of the tumor were from 28 to 50 mm to the edge of anus,averaging 42 mm.Results Sixty patients underwent intersphincteric resection successfully with 3 cases developing anastomotic leakage and 2 cases anastomotic stenosis postoperatively.After a median follow-up period of 49 months (range from 18 to 90 months),local and distant recurrence were observed in 6 and 4 patients respectively.Five-year overall survival rate and disease-free survival rate were 88.3％ and 83.3％ respectively.The mean stool frequency were (3.8 ± 1.3) times in each day based on data from 53 patients,and the stool control function of 73.6％ of all patients was preserved satisfactorily according to Kirwan classification.Conclusions This study indicated that intersphincteric resection might be a candidate technique in the treatment of early stage ultra-low rectal cancer restricted within rectal wall and could achieve satisfactory long-term results in both oncologic and functional respects.
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ObjectiveTo investigate the clinical effect of the double stapling technique for anus-preserved (Dixon) and Miles procedure of rectal carcinoma. MethodsFifty-eight cases were divided into 29 cases as control group and 29 cases as observation group by digital table method. The distance of their carcinoma was 4-7 cm to anus. The control group was treated with Miles procedure of rectal carcinoma, the observation group was treated with double stapling technique for Dixon. ResultsThe operation time of observation group was ( 180 ± 56) min, the control group was (240 ± 73)min(P ＜ 0.05). Five-year survival rate of observation group was 77.9％, the control group was 79.3％ (P ＞0.05);the recurrence rate of observation group was 6.9％(2/29),the control group was 6.9％(2/29) (P ＞ 0.05). In the observation group,nobody suffered encopresis after 1 year,postoperative stool frequency was ≤5 times/d,while the control group occurred encopresis gradually. ConclusionIf the distance of carcinoma is 4-7 cm to anus, the way of the double stapling technique for Dixon can get the similar short term effect with the way of Miles, and can get more ability to control it.
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PURPOSE: The conventional surgical treatment for patients with potentially curable low rectal cancer is abdominoperineal resection. Recently there has been increasing interest in the use of preoperative radiation therapy and sphincter-saving procedure as primary therapy for selected low rectal cancers. We report our institutional experience with this approach. METHODS: From 1995 to 1997, Twelve patients with resectable distal rectal cancer were offered sphincter-saving procedure, excluding the patients whose pretreatment tumor presentation demonstrated fixation to anal sphincter or puborectalis muscle. The distance from the anal verge to the distal tumor margin at initial diagnosis ranged from 1 to 5 cm. Patients received a median 50.4 Gy and chemotherapy Surgery was carried out 4 to 8 weeks after radiation. RESULTS: No patient had toxic reaction that required interruption of chemoradiation. Four patients (33%) had complete pathologic response, but one patient with complete clinical response had residual cancer. Seven patients underwent hand-sewn coloanal anastomosis and five patients transanal excision en bloc. All patients were able to successfully undergo a sphincter-saving procedure. With a mean follow-up of 23 months (range, 6~32), the authors noted no recurrence or complication. Sphincter function was good in 92%. Daily bowel movements was two (range, 1~10). CONCLUSION: Preoperative chemoradiation appears promising in terms of better patient compliance, lesser toxicity, and downstaging tumor, making the sphincter-saving procedure feasible in carefully selected cases. Surgical resection remains essential to confirm and to achieve complete clinical remission. The results of preoperative chemoradiation and sphinctersaving procedure are encouraging, but more experience is needed to determine whether this approach ultimately has similar local control and survival rate compared to standard surgery.