Experience in use of intersphincteric resection during anus-preserving operation for very low rectal cancer / 中国普通外科杂志

ABSTRACT

Objective To evaluate the results of anal function and oncologic effect of intersphincteric resection(ISR) for very low rectal cancer Methods Sixteen patients who had ISR from March 1999 to March 2006 in our hosptal.After complete dissection of the rectum and mesorectum down to the pelvic floor,the internal sphincter was separated from the external sphincter and puborectalis and resected together with the rectum,then the coloanal anastomosis was performed.On postoperative day 7,the anal contraction function training was started;on week 4,biofeedback training was started;on week 2,chemotherapy was used for Dukes B,C stage,and on week 4 radiotherapy was used.Results There was no operative mortality,and no anastomotic leakage.Colonic mucosa prolapse developed in two patients,two developed late strictures of the coloanal anastomosis and one had wound problem.At follow-up of 3 months to 7 years,there were 2 deaths from liver metastasis and 1 death from lung metastasis;no patient developed local recurrence.According to Williams continence status level,acceptable postoperative anal function were obtained in 62.5 %,80.0 %,and 84.6 % of patients at 3,6,and 12 months respectively.Conclusions ISR is safe for selected patients with very low rectal tumor,operative morbidity is low,and the curability rate and anal functional results are satisfactory.