Long-term outcomes after intersphincteric resection for low-lying rectal cancer

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Rectal Cancer Treatment

Background:

• Intersphincteric resection (ISR) is an anus-preserving surgery for very low rectal cancer.
• Advancements in ISR over the past 20 years necessitate evaluation of long-term outcomes.

Purpose of the Study:

• To investigate long-term oncologic, functional, and quality of life (QOL) outcomes after ISR.
• To compare outcomes of ISR with or without partial external sphincter resection (PESR).
• To assess the impact of preoperative chemoradiotherapy (CRT) on ISR outcomes.

Main Methods:

• A cohort of 199 patients undergoing curative ISR (with or without PESR) between 2000-2008 was analyzed.
• Patients were divided into a preoperative CRT group (49 patients) and a surgery-first group (150 patients).
• Oncologic outcomes (OS, DFS, LFS), functional outcomes (Wexner score), and QOL (SF-36, mFIQL) were assessed.

Main Results:

• 7-year overall survival (OS), disease-free survival (DFS), and local relapse-free survival (LFS) rates were 78%, 67%, and 80%, respectively.
• LFS was significantly better in the CRT group (p=0.045).
• While QOL generally improved, CRT was associated with worse incontinence scores (Wexner: 10 vs 8, p=0.01) and mFIQL scores (p=0.008).

Conclusions:

• ISR provides acceptable long-term oncologic, functional, and QOL results for very low rectal cancer.
• Preoperative CRT may enhance local control but can negatively affect functional outcomes and QOL.
• Careful patient selection and counseling regarding potential functional trade-offs are crucial.