Intersphincteric resection for very low rectal cancer: a systematic review

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Gastrointestinal Oncology

Background:

• Abdominoperineal resection (APR) has been the standard for very low rectal cancers.
• Sphincter-saving operations aim to improve patients' quality of life.
• Intersphincteric resection (ISR) is a sphincter-saving technique distinct from conventional hand-sewn coloanal anastomosis (CAA).

Purpose of the Study:

• To review the surgical, oncologic, and functional outcomes of intersphincteric resection (ISR) for very low rectal cancer.
• To assess the efficacy of ISR compared to traditional methods.

Main Methods:

• A literature review was conducted using the PubMed online database.
• Articles specifically on conventional hand-sewn CAA were excluded.
• Outcomes analyzed included mortality, morbidity, local recurrence, survival rates, and functional results.

Main Results:

• Mean mortality rate <2%; mean morbidity rate 7.7-38.3%.
• Mean local recurrence rate 0-22.7% with 40-94 months follow-up.
• Mean 5-year disease-free survival 69-86%; overall survival 79-97 months.
• Functional outcomes are generally acceptable but difficult to evaluate uniformly.

Conclusions:

• Intersphincteric resection (ISR) is surgically, oncologically, and functionally acceptable for very low rectal cancer.
• Enhanced understanding of oncology, anal physiology, and pelvic anatomy is crucial for successful ISR.
• Further experience is needed to optimize outcomes and improve patient survival.