The concept of TME was introduced by Heald in and it represents a true milestone in modern rectal cancer surgery [ 12 ]. Oncological outcomes Local recurrence is a serious concern after ISR, and occurs in the pelvic cavity including at the anastomotic site. Histopathologic tumor spread in very low rectal cancer treated with abdominoperineal resection. On the other hand, the introduction of intersphincteric resection in clinical practice has led to the possibility of sphincter preservation allied to satisfactory oncologic and functional outcomes in well selected cases. The surgical and oncological outcomes after ISR seem to be acceptable. The diffusion of stapler technology and its application in surgery started in thanks to Mark Mitchell Ravitch who introduced stapler suturing in the GI tract [ 8 ]. 
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Intersphincteric resection with excision of internal anal sphincter for conservative treatment of very low rectal cancer. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer.
Intersphincteric resection for very low rectal cancer: A review of the updated literature
However, the necessity for ISR and expectations of QoL impairment as a result of functional tumord should be fully discussed with patients before surgery. Dissection proceeds until the already dissected intraperitoneal portion of the rectum is found. Despite the technological advances over the last years, the treatment of low rectal cancer extraperitoneal remains as a surgical challenge.
Initially, high ligation of the inferior mesenteric vessels is done. The Wexner score obtained at this time showed a median value of Beneath the anal intrrsphincteric skin below the pectinate line lies the external hemorrhoidal plexus of veins, which drains into systemic veins.
November 5th DOI: Dissection of the intersphincteric space ISS between the internal anal sphincter IAS and external anal sphincter EAS is begun from the posterior side of the rectum by transecting the hiatal anococcygeal ligament. Preoperative staging and preparation Preoperative investigations consisted of a standard rectal touch, tumor biopsy with a malignant histopathology report.
The specimen is usually delivered per anum. Role of intersphincter inteesphincteric among the surgical options for cancer of the distal rectum. J Gastrointest Surg ;12 1: Despite the improvement in outcomes conferred by the addition of chemoradiation therapy to intersphincterjc cancer treatment, advances in surgical technique have significantly increased rates of sphincter preservation and the avoidance of a permanent stoma.
Possible technical modifications when performing ISR may improve functional outcomes. The pooled rate of local recurrence was 9. In conclusion, local and distant oncologic outcomes are not comprised with ISR. Rates of local recurrence following low anterior resection for the treatment of rectal reesction are commonly reported in the range of 2.
Operative technique: Intersphincteric resection
Other authors have also evaluated found ISR to be satisfactory from an oncological point of view. Transanal technique in low rectal anastomosis. Miles based his procedure on the assumption that rectal cancer spreads in a cylindrical manner both downward and upward resechion thus both abdominal- and perineal approaches are necessary to completely remove the tumor.
Intersphincteric resection for low rectal cancer: A literature search for relevant articles in the English language associated with intersphincteric resection ISR between and was undertaken.
Eur J Surg Oncol. Factors associated with oncologic outcomes following rcetal or intersphincteric resection in patients treated with preoperative chemotherapy. Intersphincteric resections seem to be a feasible option in highly selected cases with low rectal cancer that refuse the presence of a colostomy bag be it a temporary one.
Regarding quality of life QOLBretagnol et al. Conflicts of Interest Authors declare no conflicts of interest for this article.
Prognostic factors for low rectal cancer patients undergoing intersphincteric resection after neoadjuvant chemoradiation. Support Center Support Center. In recent years, intersphincteric resection ISR has been proposed to offer sphincter preservation in patients with very low rectal lesions, as an alternative to APR. Local recurrence is a serious concern after ISR, and occurs in the pelvic cavity including at the anastomotic site.
This is followed by TME down to the level of the pelvic floor. The present paper describes the technical steps of an intersphincteric resection for the treatment of extraperitoneal low rectal cancer.
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