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Long-term results of intersphincteric resection for low rectal cancer in Japan

Surgery Today volume 49, pages 275–285 (2019)Cite this article

Abstract

Intersphincteric resection (ISR) is the ultimate sphincter-preserving procedure for low rectal cancer. A questionnaire about the standardization of ISR was given to 2125 patients who underwent curative ISR for low rectal cancer between 2005 and 2012 at 127 affiliated institutions of the Japanese Society for Cancer of the Colon and Rectum (JSCCR), and the results were compared with the results of a systematic review. The findings revealed that although mortality and morbidity were relatively low and the survival rate after ISR was good, the rates of local recurrence and postoperative fecal incontinence were relatively high. The radicality of ISR was compared with that of abdominoperineal resection and low anterior resection using the propensity score matching prognosis analysis of patients in the JSCCR nationwide registry. The local recurrence rate was significantly higher after ISR, and especially high in patients with T3 (invasion into the external anal sphincter) and T4 disease. These results provide evidence about the factors related to fecal incontinence after ISR. As measures for the standardization of ISR, it is important to reconfirm that ISR is not indicated for patients with cT3 and cT4 disease and those with poor preoperative defecatory function, based on the ISR indication criteria.

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Author information

Affiliations

  1. Department of Surgery, Coloproctology Center Takano Hospital, 3-2-55 Oe, Chuo-ku, Kumamoto, 862-0971, Japan

    Kazutaka Yamada, Yasumitsu Saiki, Shota Takano, Kazutsugu Iwamoto, Masafumi Tanaka, Mitsuko Fukunaga, Tadaaki Noguchi, Yasushi Nakamura, Saburo Hisano, Kensaku Fukami, Daisaku Kuwahara, Yoriyuki Tsuji & Masahiro Takano

  2. Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Koichiro Usuku & Tokunori Ikeda

  3. The Japanese Society for Cancer of the Colon and Rectum, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan

    Kenichi Sugihara

Authors
  1. Kazutaka Yamada
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  2. Yasumitsu Saiki
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  3. Shota Takano
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  4. Kazutsugu Iwamoto
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Correspondence to Kazutaka Yamada.

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Kazutaka Yamada and his co-authors have no conflicts of interest to declare.

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The original version of this article was revised: In the original publication Figure 2 and Table 4 were incorrectly published. Figure and table are corrected.

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Yamada, K., Saiki, Y., Takano, S. et al. Long-term results of intersphincteric resection for low rectal cancer in Japan. Surg Today 49, 275–285 (2019). https://doi.org/10.1007/s00595-018-1754-4

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  • DOI: https://doi.org/10.1007/s00595-018-1754-4

Keywords

  • Low rectal cancer
  • Intersphincteric resection
  • Oncological outcome
  • Defecatory function