Clinical outcome of intersphincteric resection for ultra-low rectal cancer

To analyze oncological outcome of intersphincteric resection (ISR) in ultra-low rectal cancer with intent to spare colostoma.

From 1995 to 1998, patients with a non-fixed rectal adenocarcinoma (tumor stage T2) preserving the lower margin at 1-3 cm above the dentate line without distant metastasis was enrolled (period I). ISR was practiced in eight patients, and their postoperative follow-up was at least 5 years. In addition, from 1999 to 2003, another 10 patients having the same tumor location as period I underwent ISR (period II). Among those, 6 patients with T3-4-staged tumor received preoperative chemoradiotherapy.

All patients received ISR with curative intention and no postoperative mortality. In these case series at period I, local recurrence rate was 12.5% and metastasis rate 25.0%; the 5-year survival rate was 87.5% and disease-free survival rate 75.0%. There was no local recurrence or distant metastases in 10 patients with a median follow-up of 30 (range, 18-47) mo at period II.

As to ultra-low rectal cancer, intersphincteric resection could provide acceptable local control and cancer-related survival with no permanent stoma in early-staged tumor (tumor stage T2); moreover, preoperative concurrent chemoradiotherapy would make ISR feasible with surgical curative intent in more advanced tumors (tumor stages T3-4).