Annals of Surgical Oncology

, Volume 21, Supplement 3, pp 422–428 | Cite as

Long-Term Clinical and Functional Results of Intersphincteric Resection for Lower Rectal Cancer

  • Motoi Koyama
  • Akihiro Murata
  • Yoshiyuki Sakamoto
  • Hajime Morohashi
  • Seiji Takahashi
  • Eri Yoshida
  • Kenichi Hakamada
Colorectal Cancer



Intersphincteric resection (ISR) is an alternative to abdominoperineal resection (APR) for super-low rectal cancer. The aim of this study was to evaluate the long-term curability after ISR over an average 6-year observational period, to compare the postoperative functional outcomes for ISR with those for low anterior resection (LAR), and to determine whether ISR is a function-preserving surgery.


Between 2000 and 2007, a total of 77 consecutive patients with low rectal cancer underwent curative ISR. The curability outcomes for ISR, LAR, and APR were compared. We evaluated the postoperative defecation functions, Wexner incontinence score (WIS), and defecation quality of life (QOL) for a between-groups comparison (ISR/LAR).


The 5-year survival rate after ISR was 76.4 %, and the outcome was better than for APR (APR 51.2 %, LAR 80.7 %). Local recurrence after ISR occurred in 7.8 % of patients (APR 12.1 %, LAR 11.7 %). The average daily frequency of defecation was 3.7 times for the ISR patients and 3.2 times for the LAR patients, indicating no significant difference between the groups. Moreover, there were no significant differences between the groups for defecation functions. The WIS was 8.1 for ISR and 4.9 for LAR, and the defecation QOL for ISR and LAR was not significantly different (modified fecal incontinence QOL score: ISR 34.3, LAR 26.5).


The long-term clinical and functional results suggest that ISR may be the optimal sphincter-preserving surgery for patients with lower rectal cancers who cannot be treated with a double-stapling technique.


Lower Rectal Cancer Staple Anastomosis Wexner Score Intersphincteric Resection Wexner Incontinence Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This study received no financial support. We thank the Department of Pathology staff at our institute for performing the pathologic investigations.


  1. 1.
    Parks AG, Percy JP. Resection and sutured colo-anal anastomosis for rectal carcinoma. Br J Surg. 1982;69:301–4.PubMedCrossRefGoogle Scholar
  2. 2.
    Parks AG. Transanal technique in low rectal anastomosis. Proc R Soc Med. 1972;65:975–6.PubMedCentralPubMedGoogle Scholar
  3. 3.
    Teramoto T, Watanabe M, Kitajima M. Per anum intersphincteric rectal dissection with direct coloanal anastomosis for lower rectal cancer: the ultimate sphincter-preserving operation. Dis Colon Rectum. 1997;40:S43–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Quirke P, Durdey P, Dixon MF, et al. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection; histopathological study of lateral tumour spread and surgical excision. Lancet. 1986;38:996–9.CrossRefGoogle Scholar
  5. 5.
    Nicholls RJ, Hall C. Treatment of non-disseminated cancer of the lower rectum. Br J Surg. 1996;83:15–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Schiessel R, Karner-Hanusch J, Herbst F, et al. Intersphincteric resection for low rectal tumours. Br J Surg. 1994;81:1376–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Braun J, Treutner KH, Winkeltau G, et al. Results of intersphincteric resection of the rectum with direct coloanal anastomosis for rectal carcinoma. Am J Surg. 1992;163:407–12.PubMedCrossRefGoogle Scholar
  8. 8.
    Rullier E, Zerbib F, Laurent C, et al. Intersphincteric resection with excision of internal anal sphincter for conservative treatment of very low rectal cancer. Dis Colon Rectum. 1999;42:1168–75.PubMedCrossRefGoogle Scholar
  9. 9.
    Köhler A, Athanasiadis S, Ommer A, et al. Long-term results of low anterior resection with intersphincteric anastomosis in carcinoma of the lower one-third of the rectum: analysis of 31 patients. Dis Colon Rectum. 2000;43:843–50.PubMedCrossRefGoogle Scholar
  10. 10.
    Yamada K, Ogata S, Saiki Y, et al. Long-term results of intersphincteric resection for low rectal cancer. Dis Colon Rectum. 2009;52:1065–71.PubMedCrossRefGoogle Scholar
  11. 11.
    Schiessel R, Novi G, Holzer B, et al. Technique and long-term results of intersphincteric resection for low rectal cancer. Dis Colon Rectum. 2005;48:1858–67.PubMedCrossRefGoogle Scholar
  12. 12.
    Portier G, Ghouti L, Kirzin S, et al. Oncological outcome of ultra-low coloanal anastomosis with and without intersphincteric resection for low rectal adenocarcinoma. Br J Surg. 2007;94:341–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Chamlou R, Parc Y, Simon T, et al. Long-term results of intersphincteric resection for low rectal cancer. Ann Surg. 2007;246:916–21.PubMedCrossRefGoogle Scholar
  14. 14.
    Akasu T, Takawa M, Yamamoto S, et al. Incidence and patterns of recurrence after intersphincteric resection for very low rectal adenocarcinoma. J Am Coll Surg. 2007;205:642–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Saito N, Sugito M, Ito M, et al. Oncologic outcome of intersphincteric resection for very low rectal cancer. World J Surg. 2009;33:1750–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Weiser MR, Quah HM, Shia J, et al. Sphincter preservation in low rectal cancer is facilitated by preoperative chemoradiation and intersphincteric dissection. Ann Surg. 2009;249:236–42.PubMedCrossRefGoogle Scholar
  17. 17.
    Tiret E, Poupardin B, McNamara D, et al. Ultralow anterior resection with intersphincteric dissection: what is the limit of safe sphincter preservation? Colorectal Dis. 2003;5:454–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Saito N, Ono M, Sugito M, et al. Early results of intersphincteric resection for patients with very low rectal cancer: an active approach to avoid a permanent colostomy. Dis Colon Rectum. 2004;47:459–66.PubMedCrossRefGoogle Scholar
  19. 19.
    Bretagnol F, Rullier E, Laurent C, et al. Comparison of functional results and quality of life between intersphincteric resection and conventional coloanal anastomosis for low rectal cancer. Dis Colon Rectum. 2004;47:832–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Saito N, Moriya Y, Shirouzu K, et al. Intersphincteric resection in patients with very low rectal cancer: a review of the Japanese experience. Dis Colon Rectum. 2006;49:S13–22.PubMedCrossRefGoogle Scholar
  21. 21.
    Yamada K, Ogata S, Saiki Y, et al. Functional results of intersphincteric resection for low rectal cancer. Br J Surg. 2007;94:1272–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Ito M, Saito N, Sugito M, et al. Analysis of clinical factors associated with anal function after intersphincteric resection for very low rectal cancer. Dis Colon Rectum. 2009;52:64–70.PubMedCrossRefGoogle Scholar
  23. 23.
    Pollett WG, Nicholls RJ. The relationship between the extent of distal clearance and survival and local recurrence rates after curative anterior resection for carcinoma of the rectum. Ann Surg. 1983;198:159–63.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Rullier E, Laurent C, Bretagnol F, et al. Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule. Ann Surg. 2005;241:465–9.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;28:1479–82.CrossRefGoogle Scholar
  26. 26.
    Sugihara K, Moriya Y, Akasu T, et al. Pelvic autonomic nerve preservation for patients with rectal carcinoma: oncologic and functional outcome. Cancer 1996;78:1871–80.PubMedCrossRefGoogle Scholar
  27. 27.
    Mori T, Takahashi K, Yasuno M. Radical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: the impact of lateral lymph node dissection. Langenbecks Arch Surg. 1998;383:409–15.PubMedCrossRefGoogle Scholar
  28. 28.
    Hida J, Yasutomi M, Fujimoto K, et al. Functional outcome after low anterior resection with low anastomosis for rectal cancer using the colonic J-pouch: prospective randomized study for determination of optimum pouch size. Dis Colon Rectum. 1996;39:986–91.PubMedCrossRefGoogle Scholar
  29. 29.
    Fürst A, Suttner S, Agha A, et al. Colonic J-pouch vs. coloplasty following resection of distal rectal cancer: early results of a prospective, randomized, pilot study. Dis Colon Rectum. 2003;46:1161–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36:77–97.PubMedCrossRefGoogle Scholar
  31. 31.
    Hashimoto H, Shiokawa H, Funahashi K, et al. Development and validation of a modified fecal incontinence quality of life scale for Japanese patients after intersphincteric resection for very low rectal cancer. J Gastroenterol. 2010;45:928–35.PubMedCrossRefGoogle Scholar
  32. 32.
    McDermott FT, Hughes ES, Pihl E, et al. Local recurrence after potentially curative resection for rectal cancer in a series of 1008 patients. Br J Surg. 1985;72:34–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Rullier E, Laurent C, Carles J, et al. Local recurrence of low rectal cancer after abdominoperineal and anterior resection. Br J Surg. 1997;84:525–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Wibe A, Syse A, Andersen E, et al.; Norwegian Rectal Cancer Group. Oncological outcomes after total mesorectal excision for cure for cancer of the lower rectum: anterior vs. abdominoperineal resection. Dis Colon Rectum. 2004;47:48–58.PubMedCrossRefGoogle Scholar
  35. 35.
    Paty PB, Enker WE, Cohen AM, et al. Treatment of rectal cancer by low anterior resection with coloanal anastomosis. Ann Surg. 1994;219:365–73.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Takase Y, Oya M, Komatsu J. Clinical and functional comparison between stapled colonic J-pouch low rectal anastomosis and hand-sewn colonic J-pouch anal anastomosis for very low rectal cancer. Surg Today. 2002;32:315–21.PubMedCrossRefGoogle Scholar
  37. 37.
    Kusunoki M, Shoji Y, Yanagi H, et al. Function after anoabdominal rectal resection and colonic J pouch: anal anastomosis. Br J Surg. 1991;78:1434–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Lazorthes F, Chiotasso P, Gamagami RA, et al. Late clinical outcome in a randomized prospective comparison of colonic J pouch and straight coloanal anastomosis. Br J Surg. 1997;84:1449–51.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Motoi Koyama
    • 1
  • Akihiro Murata
    • 1
  • Yoshiyuki Sakamoto
    • 1
  • Hajime Morohashi
    • 1
  • Seiji Takahashi
    • 1
  • Eri Yoshida
    • 1
  • Kenichi Hakamada
    • 1
  1. 1.Department of Gastroenterological SurgeryHirosaki University Graduate School of MedicineAomoriJapan

Personalised recommendations