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Outcomes of ultra-low anterior resection combined with or without intersphincteric resection in lower rectal cancer patients.

Abstract：

PURPOSE:We evaluated the current practice of ultra-low anterior resection (uLAR) in patients with lower rectal cancer and compared uLARs using mostly transabdominal approach with or without intersphincteric resection (ISR). METHODS:A total of 624 consecutive lower rectal cancer patients undergoing curative uLAR were prospectively enrolled as ISR+ vs. ISR- groups (329 vs. 295 patients) between 2005 and 2012. The ISR+ group additionally received levator-sphincter reinforcement after distal resection. RESULTS:The circumferential resection margin (CRM) + rate (≤1 mm) was 2.1 % in the two groups. Postoperative ileus occurred more in the ISR- group than in the ISR+ group (p = 0.02). Substantial erectile dysfunction occurred 1.8 times more frequently in the ISR- group than in the ISR+ group (32 vs. 18.1 %; p = 0.01) among male patients at 2 years postoperatively. The urge to defecate volume and maximal tolerance volume, closely correlated with maximal squeezing pressure and/or mean resting pressure, did not differ between patients with and without chemoradiotherapy until 24 months postoperatively. Nevertheless, the urge to defecate volume was lesser in the ISR- group than in the ISR+ group at 24 months postoperatively (p = 0.022). For 301 patients in which >5 years had elapsed postoperatively, the mean 5-year local recurrence rate was 4.3 %, and the 5-year disease-free and overall survival rates were 78.9 and 92 %, respectively, without differences between the two groups. CONCLUSIONS:Compared with uLAR without ISR, the transabdominal ISR with levator-sphincter reinforcement provides a safe resection plane with competent CRM, concurrently reduces substantial complications, and marginally promotes recovery of neorectal function.

journal_name

Int J Colorectal Dis

journal_title

International journal of colorectal disease

authors

Kim JC,Yu CS,Lim SB,Kim CW,Park IJ,Yoon YS

doi

10.1007/s00384-015-2303-x

subject

Has Abstract

pub_date

2015-10-01 00:00:00

pages

1311-21

issue

eissn

0179-1958

issn

1432-1262

pii

10.1007/s00384-015-2303-x

journal_volume

pub_type

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Outcomes of ultra-low anterior resection combined with or without intersphincteric resection in lower rectal cancer patients.