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Laparoscopic intersphincteric resection: indications and results

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Abstract

Surgical treatment of distal rectal cancer has long been based only on abdominoperineal excision, resulting in a permanent stoma and not always offering a definitive local control. Sphincter saving surgery has emerged in the last 20 years and can be offered also to patients with low lying tumours, provided that the external sphincter is not involved by the disease. An intersphincteric resection (ISR) is based on the resection of the rectum with a distal dissection proceeding into the space between the internal and the external anal sphincter. Originally described as an open procedure, it has also been developed with the laparoscopic approach, and also this technically demanding procedure is inscribed among those offered to the patient by a minimally invasive surgery. Indications have to be strict and patient selection is crucial to obtain both oncological and functional optimal results. The level of distal dissection and the extent of internal sphincter resected are chosen according to the distal margin of the tumour and is based on MRI findings: accurate imaging is therefore mandatory to better define the surgical approach. We here present our actual indications for ISR, results in terms of operative time, median hospital stay for ISR in our experience and review the updated literature.

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Authors and Affiliations

  1. Colorectal Surgical Oncology, Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, “Fondazione Giovanni Pascale” IRCCS, Naples, Italy

    Dario Scala, Antonello Niglio, Ugo Pace, Fulvio Ruffolo, Daniela Rega & Paolo Delrio

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  1. Dario Scala
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  2. Antonello Niglio
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  3. Ugo Pace
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  4. Fulvio Ruffolo
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Correspondence to Dario Scala.

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All procedures in our paper were in accordance with the ethical standards of the institutional as well as national research committee and with the 1964 Helsinki declaration and its later amendments.

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Scala, D., Niglio, A., Pace, U. et al. Laparoscopic intersphincteric resection: indications and results. Updates Surg 68, 85–91 (2016). https://doi.org/10.1007/s13304-016-0351-6

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