Ultimate Functional Preservation With Intersphincteric Resection for Rectal Cancer.

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Rectal cancer near the anal sphincter presents a challenge in balancing oncological safety and anal continence preservation.
• Intersphincteric resection (ISR) is an alternative to abdominoperineal resection (APR), but requires careful patient selection.

Purpose of the Study:

• To outline the anatomical, oncological, and functional considerations for selecting patients for ISR.
• To detail the surgical principles for safe and effective ISR in very low rectal cancer.

Main Methods:

• Literature review of anatomical considerations, oncological outcomes, and functional results of ISR.
• Analysis of selection criteria and surgical principles for ISR.

Main Results:

• ISR offers a 5-year disease-free survival of 80.2% with a 5.8% local recurrence rate when performed with adequate resection margins (CRM ≥ 1 mm, distal margin ≥ 1 cm).
• Pre-operative assessment of functional outcomes and quality of life is essential due to the impact of internal sphincter resection.

Conclusions:

• ISR is a safe and effective option for selected patients with very low rectal cancer, achieving good oncological and functional results.
• Precise patient selection and adherence to surgical principles are paramount for successful anal sphincter preservation during ISR.