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Surgery Today

, Volume 43, Issue 8, pp 838–847 | Cite as

Intersphincteric resection for very low rectal cancer: a systematic review

  • Yoshito Akagi
  • Tetsushi Kinugasa
  • Kazuo Shirouzu
Review Article

Abstract

Radical surgical treatment for very low rectal cancer near the anus has generally involved abdominoperineal resection. Various sphincter-saving operations have been developed for such tumors to optimize the patients’ postoperative quality of life. Current protocols focus on intersphincteric resection (ISR), which differs from conventional hand-sewn coloanal anastomosis (CAA) after low anterior resection. However, the efficacy of ISR remains unclear. The surgical, oncologic, and functional outcomes after intersphincteric resection (ISR) were reviewed. This review of the current literature was conducted by searching the PubMed online database. Articles focusing specifically on conventional hand-sewn CAA were excluded from this study. The mean mortality rate is <2 %, and the mean morbidity rate ranges from 7.7 to 38.3 %. The mean local recurrence rate varies widely from 0 to 22.7 %, with a mean follow-up duration of 40–94 months. The mean disease-free and overall 5-year survival rates are 69–86 and 79–97 months, respectively. Functional outcomes are generally acceptable, but accurate evaluation is extremely difficult due to the absence of unified appraisal methods. ISR appears surgically, oncologically and functionally acceptable. However, more experience and better understanding of the oncology, anal physiology, and pelvic anatomy are necessary to achieve successful outcomes without complications, and to improve patient survival.

Keywords

Rectal cancer Intersphincteric resection Local recurrence Survival 

Notes

Acknowledgments

Sponsorship or grants: this study was not performed under any commercial sponsorship or grant.

Conflict of interest

The authors declare that there is nothing to disclose.

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Copyright information

© Springer Japan 2012

Authors and Affiliations

  • Yoshito Akagi
    • 1
  • Tetsushi Kinugasa
    • 1
  • Kazuo Shirouzu
    • 1
  1. 1.Department of SurgeryKurume University School of MedicineKurumeJapan

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