Abstract
Background
There are no published data concerning management of patients with exteriorized colonic prolapse (CP) after intersphincteric rectal resection (ISR) and side-to-end coloanal manual anastomosis (CAA) for very low rectal cancer. The aim of the present study was to report our experience in 12 consecutive cases of CP following ISR with CAA.
Methods
From 2006 to 2014, all patients with very low rectal cancer who developed CP after ISR and CAA were reviewed. Demographic and surgical data, prolapse symptoms and treatment were recorded. Postoperative morbidity, functional outcomes and results after prolapse surgery were recorded.
Results
Twelve out of 143 patients (8 %) who underwent ISR with side-to-end CAA for low rectal cancer presented CP: 7/107 ISR (7 %) with partial resection of the internal anal sphincter (IAS) and 5/36 ISR (14 %) with subtotal or total resection of the IAS (NS). CP was diagnosed after a median of 6 months (range 2–72 months) after ISR. All patients with CP suffered from pain and fecal incontinence. Median Wexner fecal incontinence score before surgery was 16.5 (range 12–20). Three patients refused reoperation. Nine patients underwent transanal surgery with prolapse resection (including colonic stump and side-to-end anastomosis) and new end-to-end CAA (with posterior myorraphy in 4 cases). After a median follow-up of 30 months (range 8–87 months), 3/9 patients (33 %) had CP recurrence: One with very poor function was treated by abdominoperineal resection and definitive stoma. The 2 others were successfully reoperated on transanally. Median Wexner fecal incontinence score after CP surgery was 9 (range 0–20). No CP recurrence was noted for the 6 other patients, and function improved in all cases. Thus, at the end of follow-up, 8/9 patients (89 %) had no recurrence after surgery.
Conclusions
We believe surgery must be attempted in these patients who develop CP after ISR with CAA for very low rectal cancer in order to improve function and symptoms. A transanal approach with CP resection and new end-to-end anastomosis appeared to be safe and effective. Larger studies are needed to confirm our results.
Similar content being viewed by others
References
Portier G, Ghouti L, Kirzin S, Guimbaud R, Rives M, Lazorthes F (2007) Oncological outcome of ultra-low coloanal anastomosis with and without intersphincteric resection for low rectal adenocarcinoma. Br J Surg 94:341–345
Chau A, Maggiori L, Hennequin C, Kanso F, Debove C, Panis Y (2014) Towards the end of abdominoperineal resection for rectal cancer? a decade of surgical advances in 401 consecutive patients with rectal cancer. Ann Surg 260:801–805
Martin ST, Heneghan HM, Winter DC (2012) Systematic review of outcomes after intersphincteric resection for low rectal cancer. Br J Surg 99:603–612
Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97
Maggiori L, Bretagnol F, Aslam MI et al (2014) Does pathologic response of rectal cancer influence postoperative morbidity after neoadjuvant radiochemotherapy and total mesorectal excision? Surgery 155:468–475
Altemeier WA, Culbertson WR, Alexander JW (1964) One-stage perineal repair of rectal prolapse: twelve years experience. Arch Surg 89:6–16
Tobin SA, Scott IH (1994) Delorme operation for rectal prolapse. Br J Surg 81:1681–1684
Goldstein SD, Maxwell PJ (2011) 4th: rectal prolapse. Clin Colon Rectal Surg 24:39–45
Bannon JP, Marks GJ, Mohiuddin M, Rakinic J, Jian NZ, Nagle D (1995) Radical and local excisional methods of sphincter-sparing surgery after high-dose radiation for cancer of the distal 3 cm of the rectum. Ann Surg Oncol 2:221–222
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:S13–S22
Yamada K, Ogata S, Saiki Y, Fukunaga M, Tsuji Y, Takano M (2009) Long-term results of intersphincteric resection for low rectal cancer. Dis Colon Rectum 52:1065–1071
Lim SW, Huh JW, Kim YJ, Kim HR (2011) Laparoscopic intersphincteric resection for low rectal cancer. World J Surg 35:2811–2817
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
This study was conducted according to the ethical standards of our institutional committee on Human experimentation (Approval of the IRB of the hospital).
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Chau, A., Frasson, M., Debove, C. et al. Colonic prolapse after intersphincteric resection for very low rectal cancer: a report of 12 cases. Tech Coloproctol 20, 701–705 (2016). https://doi.org/10.1007/s10151-016-1522-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10151-016-1522-7