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Intersphincteric Resection in Patients with Very Low Rectal Cancer: A Review of the Japanese Experience

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Diseases of the Colon & Rectum

Purpose

This study was designed to evaluate the feasibility and oncologic and functional outcomes of intersphincteric resection for very low rectal cancer.

Methods

A feasibility study was performed using 213 specimens from abdominoperineal resections of rectal cancer. Oncologic and functional outcomes were investigated in 228 patients with rectal cancer located <5 cm from the anal verge who underwent intersphincteric resection at seven institutions in Japan between 1995 and 2004.

Results

Curative operations were accomplished by intersphincteric resection in 86 percent of patients who underwent abdominoperineal resection. Complete microscopic curative surgery was achieved by intersphincteric resection in 225 of 228 patients. Morbidity was 24 percent, and mortality was 0.4 percent. During the median observation time of 41 months, rate of local recurrence was 5.8 percent at three years, and five-year overall and disease-free survival rates were 91.9 percent and 83.2 percent, respectively. In 181 patients who received stoma closure, 68 percent displayed good continence, and only 7 percent showed worsened continence at 24 months after stoma closure. Patients with total intersphincteric resection displayed significantly worse continence than patients with partial or subtotal resection.

Conclusions

Curability with intersphincteric resection was verified histologically, and acceptable oncologic and functional outcomes were obtained by using these procedures in patients with very low rectal cancer. However, information on potential functional adverse effects after intersphincteric resection should be provided to patients preoperatively.

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Acknowledgments

Patients with intersphincteric resection studied in this series were registered from the following institutions: Department of Surgical Oncology, National Cancer Center Hospital East, Kashiwa, Japan; Department of Surgery, National Cancer Center Hospital, Tokyo, Japan; Department of Surgery, Faculty of Medicine, Kurume University, Kurume, Japan; Department of Surgery, Fujita Health University, Toyoake, Japan; Department of Surgery 1, National Defense Medical College, Tokorozawa, Japan; Department of Gastroenterological Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan.

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Authors and Affiliations

  1. Department of Surgical Oncology, National Cancer Center Hospital East, Kashiwa, Japan

    Norio Saito M.D., Masanori Sugito M.D., Masaaki Ito M.D. & Akihiro Kobayashi M.D.

  2. Department of Surgery, National Cancer Center Hospital, Tokyo, Japan

    Yoshihiro Moriya M.D.

  3. Department of Surgery, Faculty of Medicine, Kurume University, Kurume, Japan

    Kazuo Shirouzu M.D.

  4. Department of Surgery, Fujita Health University, Toyoake, Japan

    Koutarou Maeda M.D.

  5. Department of Surgery 1, National Defense Medical College, Tokorozawa, Japan

    Hidetaka Mochizuki M.D.

  6. Department of Gastroenterological Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan

    Keiji Koda M.D.

  7. Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan

    Takashi Hirai M.D.

  8. Colorectal and Pelvic Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Norio Saito M.D.

Authors
  1. Norio Saito M.D.
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  2. Yoshihiro Moriya M.D.
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  3. Kazuo Shirouzu M.D.
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  4. Koutarou Maeda M.D.
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  5. Hidetaka Mochizuki M.D.
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  6. Keiji Koda M.D.
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  7. Takashi Hirai M.D.
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  8. Masanori Sugito M.D.
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  9. Masaaki Ito M.D.
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  10. Akihiro Kobayashi M.D.
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Corresponding author

Correspondence to Norio Saito M.D..

Additional information

Sponsored by a Grant-in-Aid (14-10) for Cancer Research from the Ministry of Health, Welfare and Labor of Japan.

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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 49 (Suppl 1), S13–S22 (2006). https://doi.org/10.1007/s10350-006-0598-y

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  • DOI: https://doi.org/10.1007/s10350-006-0598-y

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