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Outcomes of ultra-low anterior resection combined with or without intersphincteric resection in lower rectal cancer patients

International Journal of Colorectal Disease volume 30, pages 1311–1321 (2015)Cite this article

Abstract

Purpose

We evaluated the current practice of ultra-low anterior resection (uLAR) in patients with lower rectal cancer and compared uLARs using mostly transabdominal approach with or without intersphincteric resection (ISR).

Methods

A total of 624 consecutive lower rectal cancer patients undergoing curative uLAR were prospectively enrolled as ISR+ vs. ISR− groups (329 vs. 295 patients) between 2005 and 2012. The ISR+ group additionally received levator-sphincter reinforcement after distal resection.

Results

The circumferential resection margin (CRM) + rate (≤1 mm) was 2.1 % in the two groups. Postoperative ileus occurred more in the ISR– group than in the ISR+ group (p = 0.02). Substantial erectile dysfunction occurred 1.8 times more frequently in the ISR– group than in the ISR+ group (32 vs. 18.1 %; p = 0.01) among male patients at 2 years postoperatively. The urge to defecate volume and maximal tolerance volume, closely correlated with maximal squeezing pressure and/or mean resting pressure, did not differ between patients with and without chemoradiotherapy until 24 months postoperatively. Nevertheless, the urge to defecate volume was lesser in the ISR− group than in the ISR+ group at 24 months postoperatively (p = 0.022). For 301 patients in which >5 years had elapsed postoperatively, the mean 5-year local recurrence rate was 4.3 %, and the 5-year disease-free and overall survival rates were 78.9 and 92 %, respectively, without differences between the two groups.

Conclusions

Compared with uLAR without ISR, the transabdominal ISR with levator-sphincter reinforcement provides a safe resection plane with competent CRM, concurrently reduces substantial complications, and marginally promotes recovery of neorectal function.

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Fig. 1
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Abbreviations

uLAR:

Ultra-low anterior resection

SSO:

Sphincter-saving operation

ISR:

Intersphincteric resection

CRT:

Chemoradiotherapy

AV:

Anal verge

ECOG:

Eastern Cooperative Oncology Group

CT:

Computed tomography

MRI:

Magnetic resonance imaging

EUS:

Endorectal ultrasonography

FL:

5-fluoroural and leucovorin

TME:

Total mesorectal excision

CRM:

Circumferential resection margin

OR:

Odds ratio

CI:

Confidence interval

LVI:

Lymphovascular invasion

PNI:

Perineural invasion

DFS:

Disease-free survival

OS:

Overall survival

s-CEA:

Serum carcinoembryonic antigen

APR:

Abdominoperineal resection

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Acknowledgement

This work was supported by the Grants (to J. C. Kim) from the Korea Research Foundation (2013R1A2A1A03070986); Ministry of Science, ICT, and Future Planning; the Korea Health 21 R&D Project (HI06C0868 and HI13C1750), and the Center for Development and Commercialization of Anti-Cancer Therapeutics (HI10C2014), Ministry of Health and Welfare, Republic of Korea.

Conflict of interest

The authors declare that they have no competing interests.

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Affiliations

  1. Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea

    Jin C. Kim, Chang S. Yu, Seok-B Lim, Chan W. Kim, In J. Park & Yong S. Yoon

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  1. Jin C. Kim
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  2. Chang S. Yu
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Correspondence to Jin C. Kim.

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Kim, J.C., Yu, C.S., Lim, SB. et al. Outcomes of ultra-low anterior resection combined with or without intersphincteric resection in lower rectal cancer patients. Int J Colorectal Dis 30, 1311–1321 (2015). https://doi.org/10.1007/s00384-015-2303-x

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Keywords

  • Lower rectal cancer
  • Ultra-low anterior resection (uLAR)
  • Intersphincteric resection (ISR)
  • Levator-sphincter reinforcement (LSR)
  • Outcome