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

Journal of Gastrointestinal Surgery volume 21, pages 885–891 (2017)Cite this article

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Abbreviations

APR:

Abdominoperineal resection

CRM:

Circumferential resection margin

EORTC:

European Organisation for Research and Treatment of Cancer

ISR:

Intersphincteric resection

TME:

Total mesorectal excision

TNM:

Tumour Node Metastasis

UICC:

Union for International Cancer Control

QoL:

Quality of Life

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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.

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Affiliations

  1. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Johannes Klose, Ignazio Tarantino, Yakup Kulu, Stefan Trefz, Thomas Schmidt, Martin Schneider, Thilo Hackert, Markus W. Büchler & Alexis Ulrich

  2. Institute for Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany

    Thomas Bruckner

Authors
  1. Johannes Klose
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  2. Ignazio Tarantino
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  3. Yakup Kulu
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  4. Thomas Bruckner
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  5. Stefan Trefz
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  6. Thomas Schmidt
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  7. Martin Schneider
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  9. Markus W. Büchler
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  10. Alexis Ulrich
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Correspondence to Alexis Ulrich.

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Klose, J., Tarantino, I., Kulu, Y. et al. Sphincter-Preserving Surgery for Low Rectal Cancer: Do We Overshoot the Mark?. J Gastrointest Surg 21, 885–891 (2017). https://doi.org/10.1007/s11605-016-3339-0

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  • DOI: https://doi.org/10.1007/s11605-016-3339-0

Keywords

  • Rectal cancer
  • Intersphincteric resection
  • Quality of life
  • Functional outcome