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Long-term Outcomes after Intersphincteric Resection for Low-Lying Rectal Cancer

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

As an anus-preserving surgery for very low rectal cancer, intersphincteric resection (ISR), has advanced markedly over the last 20 years. We investigated long-term oncologic, functional, and quality of life (QOL) outcomes after ISR with or without partial external sphincter resection (PESR).

Methods

A series of 199 patients underwent curative ISR with or without PESR between 2000 and 2008, with 49 receiving preoperative chemoradiotherapy (CRT group) and 150 undergoing surgery first (surgery group). Overall survival (OS), disease-free survival (DFS), and local relapse-free survival (LFS) rates were calculated using Kaplan–Meier methods. Functional outcomes were assessed using the Wexner incontinence score. QOL was investigated using the Short-Form 36 questionnaire (SF-36) and modified fecal incontinence quality of life (mFIQL) scale.

Results

After a median follow-up of 78 months (range 12–164 months), estimated 7-year OS, DFS, and LFS rates were 78, 67, and 80 %, respectively. LFS was better in the CRT group than in the surgery group (p = 0.045). Patients with PESR or positive circumferential resection margins showed significantly worse survival. The median Wexner incontinence score at >5 years was 8 in the surgery group and 10 in the CRT group (p = 0.01). QOL was improved in all physical and mental subscales of the SF-36 at >5 years. Although the mFIQL showed a relatively good score in all groups at >5 years, a significant difference existed between the CRT and surgery groups (p = 0.008).

Conclusions

With long-term follow-up, oncologic, functional, and QOL results after ISR appear acceptable, although CRT is associated with disturbance.

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Acknowledgment

This study was supported in part by a Grant-in-Aid from the National Cancer Center (NCC) Research and Development Fund (23-A-26) in Japan.

Conflict of interest

The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan

    Norio Saito MD, PhD, Masaaki Ito MD, PhD, Akihiro Kobayashi MD, PhD, Yusuke Nishizawa MD, PhD, Yuji Nishizawa MD, PhD & Masanori Sugito MD, PhD

  2. Pathology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Chiba, Japan

    Motohiro Kojima MD, PhD

Authors
  1. Norio Saito MD, PhD
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  2. Masaaki Ito MD, PhD
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  3. Akihiro Kobayashi MD, PhD
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  4. Yusuke Nishizawa MD, PhD
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  5. Motohiro Kojima MD, PhD
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  6. Yuji Nishizawa MD, PhD
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  7. Masanori Sugito MD, PhD
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Corresponding author

Correspondence to Norio Saito MD, PhD.

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Saito, N., Ito, M., Kobayashi, A. et al. Long-term Outcomes after Intersphincteric Resection for Low-Lying Rectal Cancer. Ann Surg Oncol 21, 3608–3615 (2014). https://doi.org/10.1245/s10434-014-3762-y

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  • DOI: https://doi.org/10.1245/s10434-014-3762-y

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