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Long-Term Functional and Oncological Outcomes Following Intersphincteric Resection for Low Rectal Cancers

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Abstract

Surgery for low rectal cancer often involves a permanent stoma. Intersphincteric resection (ISR) with colo-anal anastomosis is a valuable sphincter sparing surgical procedure that avoids the need for permanent stoma in patients with low rectal cancer. The aim of this study was to analyze the long-term functional and oncological outcomes following ISR. This was a retrospective analysis of patients with low rectal cancer who underwent ISR with colo-anal anastomosis in our institution between 2007 and 2015. All patients had a diversion stoma. Bowel function outcomes were assessed prospectively using Wexner incontinence score, low anterior resection syndrome score (LARS), and the Cancer Institute Quality of Life (QoL) questionnaire. The histological reports were reviewed to assess the oncological adequacy of the surgery. Patterns of recurrence and survival were analyzed in this group of patients. Thirty-three patients who underwent an ISR were eligible for this study. Laparoscopic resection was performed in five patients. All the patients received neoadjuvant chemoradiation except the two who received short course radiation and one who did not receive any neoadjuvant treatment. The median distance from the anal verge to the distal edge of the tumor was 3 cm (range 1.5–5 cm). Distal resection margins and circumferential resection margins were negative in all the patients. The 30-day post-operative mortality rate was 3.03%. In 20 patients with a median follow-up of 48 months, the 3-year overall survival was 95%. One patient had recurrence in the para-aortic nodes. No patient had a local recurrence. Bowel function was assessed in 18 patients who had a minimum stoma free period of 1 year. After a median of 43 months following stoma closure, the median Wexner score was 3.56 (range 0–19), median LARS score was 4.78 (range 0–33), and the mean Cancer Institute QoL score was 151.56 ± 15.741. The QoL was average to very high with an overall acceptable quality of life. In this study, ISR was associated with acceptable long-term functional and oncological outcomes. It can be considered as a safe alternative to a permanent stoma in selected patients with low rectal cancer.

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References

  1. Forman D, Bray F, Brewster DH, et al (2013) Cancer incidence in five continents, Vol. X (electronic version). Lyon: International Agency for Research on Cancer. IARC Scientific Publication No. 164

  2. Deepak Damodaran, Ramakrishnan A S Clinicopathological attributes and outcomes of treatment in young-onset rectal cancer. Int J Color Dis e-pub ahead of print. DOI 10.1007/s00384-015-2266-y.

  3. Shaffy SK, Karobi D (2014) Psychosocial experience of the patients with colostomy/ilesotomy: a qualitative study. Indian J Soc Psychiatry 30(1–2):28–34

    Google Scholar 

  4. Vidhubala E, Latha, Ravikannan R et al (2011) Validation of cancer institute quality of life questionnaire version II for cancer patients in India. Indian J Cancer 48(4):500–506

    Article  CAS  PubMed  Google Scholar 

  5. Emmertsen KJ, Laurberg S (2012) Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg 255(5):922–928

    Article  PubMed  Google Scholar 

  6. Jorge JMN, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon rectum 36:77–97

    Article  CAS  PubMed  Google Scholar 

  7. Pai VD, De Souza A, Patil P et al (2015) Intersphincteric resection and hand-sewn coloanal anastomosis for low rectal cancer: short-term outcomes in the Indian setting. Indian J Gastroenterol 34(1):23–28

    Article  PubMed  Google Scholar 

  8. Schiessel R, Novi G, Holzer B et al (2005) Technique and longterm results of intersphincteric resection for low rectal cancer. Dis Colon rectum 48(10):1858–1865

    Article  PubMed  Google Scholar 

  9. Rullier E, Laurent C, Bretagnol F et al (2005) Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule. Ann Surg 241:465–469

    Article  PubMed  PubMed Central  Google Scholar 

  10. Saito N, Moriya Y, Shirouzu K et al (2006) Intersphincteric resection in patients with very low rectal cancer: a review of the Japanese experience. Dis Colon rectum 49(Suppl):S13–S22

    Article  PubMed  Google Scholar 

  11. Chamlou R, Parc Y, Simon T et al (2007) Long-term results of intersphincteric resection for low rectal cancer. Ann Surg 246:916–921

    Article  PubMed  Google Scholar 

  12. Saito N, Sugito M, Ito M et al (2009) Oncologic outcome of intersphincteric resection for very low rectal cancer. World J Surg 33:1750–1756

    Article  PubMed  Google Scholar 

  13. Yamada K, Ogata S, Saiki Y et al (2009) Long-term results of intersphincteric resection for low rectal cancer. Dis Colon rectum 52:1065–1071

    Article  PubMed  Google Scholar 

  14. Silberfein EJ, Kattepogu KM, Hu CY et al (2010) Long-term survival and recurrence outcomes following surgery for distal rectal cancer. Ann Surg Oncol 17(11):2863–2869

    Article  PubMed  PubMed Central  Google Scholar 

  15. Tilney HS, Tekkis PP (2008) Extending the horizons of restorative rectal surgery: intersphincteric resection for low rectalcancer. Color Dis 1:3–15

    Google Scholar 

  16. Martin ST, Heneghan HM, Winter DC (2012) Systematic review of outcomes after intersphincteric resection for low rectal cancer. British J Surg 99:603–612

    Article  CAS  Google Scholar 

  17. Cipe G, Muslumanoglu M, Yardimci E, et al. (2012) Intersphincteric resection and coloanal anastomosis in treatment of distal rectal cancer. Int J Surg Oncol. Volume 2012, Article ID 581258, 10 pages

  18. Kuo LJ, Hung CS, Wu CH et al (2011) Oncological and functional outcomes of intersphincteric resection for low rectal cancer. J Surg Res 170:93–98

    Article  Google Scholar 

  19. Barisic G, Markovic V, Popovic M et al (2011) Function after intersphincteric resection for low rectal cancer and its influence on quality of life. Color Dis 13(6):638–643

    Article  CAS  Google Scholar 

  20. Engel J, Kerr J, Schlesinger-Raab A et al (2003) Quality of life in rectal cancer patients: a four-year prospective study. Ann Surg 238(2):203–213

    PubMed  PubMed Central  Google Scholar 

  21. Bretagnol F, Rullier E, Laurent C et al (2004) Comparison of functional results and quality of life between intersphincteric resection and conventional coloanal anastomosis for low rectal cancer. Dis Colon rectum 47:832–838

    Article  PubMed  Google Scholar 

  22. Park JS, Choi GS, Jun SH (2011) Laparoscopic versus open intersphincteric resection and coloanal anastomosis for low rectal cancer: intermediate-term oncologic outcomes. Ann Surg 254(6):941–946

    Article  PubMed  Google Scholar 

  23. Laurent C, Paumet T, Leblanc F et al (2012) Intersphincteric resection for low rectal cancer: laparoscopic vs open surgery approach. Color Dis 14(1):35–41

    Article  CAS  Google Scholar 

  24. Kang J, Hur H, Min BS (2012) Robotic coloanal anastomosis with or without intersphincteric resection for low rectal cancer: starting with the perianal approach followed by robotic procedure. Ann Surg Oncol 19(1):154–155

    Article  PubMed  Google Scholar 

  25. Leong QM, Son DN, Cho JS (2011) Robot-assisted intersphincteric resection for low rectal cancer: technique and short-term outcome for 29 consecutive patients. Surg Endosc 25(9):2987–2992

    Article  PubMed  Google Scholar 

  26. Canda AE, Terzi C, Gorken IB, Oztop I et al (2010) Effects of preoperative chemoradiotherapy on anal sphincter functions and quality of life in rectal cancer patients. International J Colorectal Disease 25(2):197–204

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgical Oncology, Cancer Institute (WIA), Dr. S. Krishnamurthy Campus, No.18, Sardar Patel Road, Guindy, Chennai, 600036, India

    Sivakumar Mahalingam & Ramakrishnan Ayloor Seshadri

  2. Department of Psycho-Oncology, Cancer Institute (WIA), Chennai, India

    Surendran Veeraiah

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  1. Sivakumar Mahalingam
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  2. Ramakrishnan Ayloor Seshadri
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  3. Surendran Veeraiah
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Correspondence to Ramakrishnan Ayloor Seshadri.

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Mahalingam, S., Seshadri, R.A. & Veeraiah, S. Long-Term Functional and Oncological Outcomes Following Intersphincteric Resection for Low Rectal Cancers. Indian J Surg Oncol 8, 457–461 (2017). https://doi.org/10.1007/s13193-016-0571-8

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  • DOI: https://doi.org/10.1007/s13193-016-0571-8

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