Journal of Gastrointestinal Surgery

, Volume 21, Issue 5, pp 885–891 | Cite as

Sphincter-Preserving Surgery for Low Rectal Cancer: Do We Overshoot the Mark?

  • Johannes Klose
  • Ignazio Tarantino
  • Yakup Kulu
  • Thomas Bruckner
  • Stefan Trefz
  • Thomas Schmidt
  • Martin Schneider
  • Thilo Hackert
  • Markus W. Büchler
  • Alexis UlrichEmail author
Original Article



Intersphincteric resection (ISR) is an alternative to abdominoperineal resection (APR) for a selected subset of patients with low rectal cancer, combining equivalent oncological outcome and sphincter preservation. However, functional results are heterogeneous and often imperfect. The aim of the present investigation was to determine the long-term functional results and quality of life after ISR.


One hundred forty-three consecutive patients who underwent surgery for low rectal cancer were analysed. Sixty patients received ISR and 83 patients APR, respectively. Kaplan-Meier estimate was used to analyse patients’ survival. The EORTC QLQ-C30, -C29 and the Wexner score were used to determine functional outcome and quality of life.


ISR and APR were both associated with comparable morbidity and no mortality. Patients’ disease- and recurrence-free survival after ISR and APR were similar (p = 0.2872 and p = 0.4635). Closure of ileostomy was performed in 73% of all patients after ISR. Long-term outcome showed a rate of incontinence (Wexner score ≥10) in 66% of the patients. Despite this, patients’ quality of life was significantly better after ISR compared to APR in terms of abdominal complaints and psycho-emotional functioning.


ISR is technically feasible with acceptable postoperative morbidity rates. Functional results following ISR are compromised by incontinence as the most important complication. However, long-term quality of life is superior to APR, which should be considered when selecting patients for ISR.


Rectal cancer Intersphincteric resection Quality of life Functional outcome 



Abdominoperineal resection


Circumferential resection margin


European Organisation for Research and Treatment of Cancer


Intersphincteric resection


Total mesorectal excision


Tumour Node Metastasis


Union for International Cancer Control


Quality of Life


Authors’ Contribution

All authors have read and approved the final manuscript. JK and AU designed the study. JK, IT, YK, ST, TS and MS were involved in data collection. JK, IT, TB, MWB and AU analysed and interpreted the data. JK, TH, MWB and AU wrote the paper. JK and AU drafted the paper.

Compliance with Ethical Standards

Conflict of Interest

The authors have nothing to disclose.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2016

Authors and Affiliations

  • Johannes Klose
    • 1
  • Ignazio Tarantino
    • 1
  • Yakup Kulu
    • 1
  • Thomas Bruckner
    • 2
  • Stefan Trefz
    • 1
  • Thomas Schmidt
    • 1
  • Martin Schneider
    • 1
  • Thilo Hackert
    • 1
  • Markus W. Büchler
    • 1
  • Alexis Ulrich
    • 1
    Email author
  1. 1.Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelbergGermany
  2. 2.Institute for Medical Biometry and InformaticsUniversity of HeidelbergHeidelbergGermany

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