Latest Advances in Intersphincteric Resection for Low Rectal Cancer
Background. Intersphincteric resection (ISR) has been a preferable alternative to abdominoperineal resection (APR) for anal preservation in patients with low rectal cancer. Laparoscopic ISR and robotic ISR have been widely used with the proposal of 2 cm or even 1 cm rule of distal free margin and th...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Gastroenterology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2020/8928109 |
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| author | Yifan Xv Jiajun Fan Yuan Ding Yang Hu Yingjie Hu Zhengjie Jiang Qingsong Tao |
| author_facet | Yifan Xv Jiajun Fan Yuan Ding Yang Hu Yingjie Hu Zhengjie Jiang Qingsong Tao |
| author_sort | Yifan Xv |
| collection | DOAJ |
| description | Background. Intersphincteric resection (ISR) has been a preferable alternative to abdominoperineal resection (APR) for anal preservation in patients with low rectal cancer. Laparoscopic ISR and robotic ISR have been widely used with the proposal of 2 cm or even 1 cm rule of distal free margin and the development of minimally invasive technology. The aim of this review was to describe the newest advancements of ISR. Methods. A comprehensive literature review was performed to identify studies on ISR techniques, preoperative chemoradiotherapy (PCRT), complications, oncological outcomes, and functional outcomes and thereby to summarize relevant information and controversies involved in ISR. Results. Although PCRT is employed to avoid positive circumferential resection margin (CRM) and decrease local recurrence, it tends to engender damage of anorectal function and patients’ quality of life (QoL). Common complications after ISR include anastomotic leakage (AL), anastomotic stricture (AS), urinary retention, fistula, pelvic sepsis, and prolapse. CRM involvement is the most important predictor for local recurrence. Preoperative assessment and particularly rectal endosonography are essential for selecting suitable patients. Anal dysfunction is associated with age, PCRT, location and growth of anastomotic stoma, tumour stage, and resection of internal sphincter. Conclusions. The ISR technique seems feasible for selected patients with low rectal cancer. However, the postoperative QoL as a result of functional disorder should be fully discussed with patients before surgery. |
| format | Article |
| id | doaj-art-cb8ef943400c4a19b015a2812684eecb |
| institution | Kabale University |
| issn | 1687-6121 1687-630X |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Gastroenterology Research and Practice |
| spelling | doaj-art-cb8ef943400c4a19b015a2812684eecb2025-02-03T05:44:12ZengWileyGastroenterology Research and Practice1687-61211687-630X2020-01-01202010.1155/2020/89281098928109Latest Advances in Intersphincteric Resection for Low Rectal CancerYifan Xv0Jiajun Fan1Yuan Ding2Yang Hu3Yingjie Hu4Zhengjie Jiang5Qingsong Tao6Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, ChinaDepartment of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, ChinaDepartment of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, ChinaDepartment of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, ChinaDepartment of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, ChinaDepartment of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, ChinaDepartment of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, ChinaBackground. Intersphincteric resection (ISR) has been a preferable alternative to abdominoperineal resection (APR) for anal preservation in patients with low rectal cancer. Laparoscopic ISR and robotic ISR have been widely used with the proposal of 2 cm or even 1 cm rule of distal free margin and the development of minimally invasive technology. The aim of this review was to describe the newest advancements of ISR. Methods. A comprehensive literature review was performed to identify studies on ISR techniques, preoperative chemoradiotherapy (PCRT), complications, oncological outcomes, and functional outcomes and thereby to summarize relevant information and controversies involved in ISR. Results. Although PCRT is employed to avoid positive circumferential resection margin (CRM) and decrease local recurrence, it tends to engender damage of anorectal function and patients’ quality of life (QoL). Common complications after ISR include anastomotic leakage (AL), anastomotic stricture (AS), urinary retention, fistula, pelvic sepsis, and prolapse. CRM involvement is the most important predictor for local recurrence. Preoperative assessment and particularly rectal endosonography are essential for selecting suitable patients. Anal dysfunction is associated with age, PCRT, location and growth of anastomotic stoma, tumour stage, and resection of internal sphincter. Conclusions. The ISR technique seems feasible for selected patients with low rectal cancer. However, the postoperative QoL as a result of functional disorder should be fully discussed with patients before surgery.http://dx.doi.org/10.1155/2020/8928109 |
| spellingShingle | Yifan Xv Jiajun Fan Yuan Ding Yang Hu Yingjie Hu Zhengjie Jiang Qingsong Tao Latest Advances in Intersphincteric Resection for Low Rectal Cancer Gastroenterology Research and Practice |
| title | Latest Advances in Intersphincteric Resection for Low Rectal Cancer |
| title_full | Latest Advances in Intersphincteric Resection for Low Rectal Cancer |
| title_fullStr | Latest Advances in Intersphincteric Resection for Low Rectal Cancer |
| title_full_unstemmed | Latest Advances in Intersphincteric Resection for Low Rectal Cancer |
| title_short | Latest Advances in Intersphincteric Resection for Low Rectal Cancer |
| title_sort | latest advances in intersphincteric resection for low rectal cancer |
| url | http://dx.doi.org/10.1155/2020/8928109 |
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