Latest Advances in Intersphincteric Resection for Low Rectal Cancer

Area of Science:

• Surgical Oncology
• Gastroenterology

Background:

• Intersphincteric resection (ISR) is a key anal-preserving alternative to abdominoperineal resection (APR) for low rectal cancer.
• Minimally invasive techniques like laparoscopic and robotic ISR are advancing, with refined distal free margin guidelines.

Purpose of the Study:

• To review the latest advancements in Intersphincteric Resection (ISR) for low rectal cancer.
• To summarize current information and controversies regarding ISR techniques, preoperative chemoradiotherapy, and outcomes.

Main Methods:

• Comprehensive literature review.
• Identification of studies on ISR techniques, preoperative chemoradiotherapy (PCRT), complications, and oncological and functional outcomes.

Main Results:

• Preoperative chemoradiotherapy (PCRT) can reduce local recurrence but may impair anorectal function and quality of life (QoL).
• Common ISR complications include anastomotic leakage, stricture, and pelvic sepsis. Circumferential resection margin (CRM) involvement predicts local recurrence.
• Patient selection via preoperative assessment, including rectal endosonography, is crucial. Anal dysfunction correlates with age, PCRT, stoma characteristics, tumor stage, and internal sphincter resection.

Conclusions:

• Intersphincteric resection (ISR) is a viable option for select low rectal cancer patients.
• Thorough discussion of potential postoperative quality of life impacts due to functional disorders is essential prior to ISR.