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Erschienen in: Diseases of the Colon & Rectum 1/2006

01.10.2006

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

verfasst von: Norio Saito, M.D., Yoshihiro Moriya, M.D., Kazuo Shirouzu, M.D., Koutarou Maeda, M.D., Hidetaka Mochizuki, M.D., Keiji Koda, M.D., Takashi Hirai, M.D., Masanori Sugito, M.D., Masaaki Ito, M.D., Akihiro Kobayashi, M.D.

Erschienen in: Diseases of the Colon & Rectum | Sonderheft 1/2006

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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.
Literatur
1.
Zurück zum Zitat Heald, RJ, Ryall, RD 1986Recurrence and survival after total mesorectal excision for rectal cancerLancet2814791482CrossRef Heald, RJ, Ryall, RD 1986Recurrence and survival after total mesorectal excision for rectal cancerLancet2814791482CrossRef
2.
Zurück zum Zitat Kapiteijn, E, Marijnen, CA, Nagtegaal, ID, et al. 2001Dutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancerN Engl J Med345638646PubMedCrossRef Kapiteijn, E, Marijnen, CA, Nagtegaal, ID,  et al. 2001Dutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancerN Engl J Med345638646PubMedCrossRef
3.
Zurück zum Zitat Miles, WE 1926Cancer of the rectumHarrisonLondon Miles, WE 1926Cancer of the rectumHarrisonLondon
4.
Zurück zum Zitat Goligher, JC, Dukes, CE, Bussey, HJ 1951Local recurrences after sphincter saving excisions for carcinoma of the rectum and rectosigmoidBr J Surg39199211PubMed Goligher, JC, Dukes, CE, Bussey, HJ 1951Local recurrences after sphincter saving excisions for carcinoma of the rectum and rectosigmoidBr J Surg39199211PubMed
5.
Zurück zum Zitat Williams, NS, Johnston, D 1983The quality of life after rectal excision for low rectal cancerBr J Surg70460462PubMed Williams, NS, Johnston, D 1983The quality of life after rectal excision for low rectal cancerBr J Surg70460462PubMed
6.
Zurück zum Zitat Sprangers, MA, Taal, BG, Aaronson, NK, Velde, A 1995Quality of life in colorectal cancer. Stoma vs. nonstoma patientsDis Colon Rectum38361369PubMedCrossRef Sprangers, MA, Taal, BG, Aaronson, NK, Velde, A 1995Quality of life in colorectal cancer. Stoma vs. nonstoma patientsDis Colon Rectum38361369PubMedCrossRef
7.
Zurück zum Zitat Schiessel, R, Karner-Hanusch, J, Herbst, F, Teleky, B, Wunderlich, M 1994Intersphincteric resection for low rectal tumoursBr J Surg8113761378PubMed Schiessel, R, Karner-Hanusch, J, Herbst, F, Teleky, B, Wunderlich, M 1994Intersphincteric resection for low rectal tumoursBr J Surg8113761378PubMed
8.
Zurück zum Zitat Braun, J, Treutner, KH, Winkeltau, G, Heidenreich, U, Lerch, MM, Schumpelick, V 1992Results of intersphincteric resection of the rectum with direct coloanal anastomosis for rectal carcinomaAm J Surg163407412PubMedCrossRef Braun, J, Treutner, KH, Winkeltau, G, Heidenreich, U, Lerch, MM, Schumpelick, V 1992Results of intersphincteric resection of the rectum with direct coloanal anastomosis for rectal carcinomaAm J Surg163407412PubMedCrossRef
9.
Zurück zum Zitat Teramoto, T, Watanabe, M, Kitajima, M 1997Per anum intersphincteric rectal dissection with direct coloanal anastomosis for lower rectal cancer: the ultimate sphincter-preserving operationDis Colon Rectum40S43S47PubMedCrossRef Teramoto, T, Watanabe, M, Kitajima, M 1997Per anum intersphincteric rectal dissection with direct coloanal anastomosis for lower rectal cancer: the ultimate sphincter-preserving operationDis Colon Rectum40S43S47PubMedCrossRef
10.
Zurück zum Zitat Rullier, E, Zerbib, F, Laurent, C, et al. 1999Intersphincteric resection with excision of internal anal sphincter for conservative treatment of very low rectal cancerDis Colon Rectum4211681175PubMedCrossRef Rullier, E, Zerbib, F, Laurent, C,  et al. 1999Intersphincteric resection with excision of internal anal sphincter for conservative treatment of very low rectal cancerDis Colon Rectum4211681175PubMedCrossRef
11.
Zurück zum Zitat Renner, K, Rosen, HR, Novi, G, Holbling, N, Schiessel, R 1999Quality of life after surgery for rectal cancer: do we still need a permanent colostomy?Dis Colon Rectum4211601167PubMedCrossRef Renner, K, Rosen, HR, Novi, G, Holbling, N, Schiessel, R 1999Quality of life after surgery for rectal cancer: do we still need a permanent colostomy?Dis Colon Rectum4211601167PubMedCrossRef
12.
Zurück zum Zitat Saito, N, Ono, M, Sugito, M, et al. 2004Early results of intersphincteric resection for patients with very low rectal cancer: an active approach to avoid a permanent colostomyDis Colon Rectum47459466PubMedCrossRef Saito, N, Ono, M, Sugito, M,  et al. 2004Early results of intersphincteric resection for patients with very low rectal cancer: an active approach to avoid a permanent colostomyDis Colon Rectum47459466PubMedCrossRef
13.
Zurück zum Zitat Rullier, E, Laurent, C, Bretagnol, F, Rullier, A, Vendrely, V, Zerbib, F 2005Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal ruleAnn Surg241465469PubMedCrossRef Rullier, E, Laurent, C, Bretagnol, F, Rullier, A, Vendrely, V, Zerbib, F 2005Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal ruleAnn Surg241465469PubMedCrossRef
14.
Zurück zum Zitat Bretagnol, F, Rullier, E, Laurent, C, Zerbib, F, Gontier, R, Saric, J 2004Comparison of functional results and quality of life between intersphincteric resection and conventional coloanal anastomosis for low rectal cancerDis Colon Rectum47832838PubMedCrossRef Bretagnol, F, Rullier, E, Laurent, C, Zerbib, F, Gontier, R, Saric, J 2004Comparison of functional results and quality of life between intersphincteric resection and conventional coloanal anastomosis for low rectal cancerDis Colon Rectum47832838PubMedCrossRef
15.
Zurück zum Zitat Shirouzu, K, Ogata, Y, Araki, Y, Kishimoto, Y, Sato, Y 2003A new ultimate anus-preserving operation for extremely low rectal cancer and for anal canal cancerTech Coloproctol7203206PubMedCrossRef Shirouzu, K, Ogata, Y, Araki, Y, Kishimoto, Y, Sato, Y 2003A new ultimate anus-preserving operation for extremely low rectal cancer and for anal canal cancerTech Coloproctol7203206PubMedCrossRef
16.
Zurück zum Zitat Shirouzu, K, Isomoto, H, Kakegawa, T 1995Distal spread of rectal cancer and optimal distal margin of resection for sphincter-preserving surgeryCancer76388392PubMedCrossRef Shirouzu, K, Isomoto, H, Kakegawa, T 1995Distal spread of rectal cancer and optimal distal margin of resection for sphincter-preserving surgeryCancer76388392PubMedCrossRef
17.
Zurück zum Zitat Sobin, LH, Wittekind, C 2002International Union Against Cancer. TNM classification of malignant tumours6Wiley-LissNew York Sobin, LH, Wittekind, C 2002International Union Against Cancer. TNM classification of malignant tumours6Wiley-LissNew York
18.
Zurück zum Zitat Moriya, Y, Sugihara, K, Akasu, T, Fujita, S 1995Nerve-sparing surgery with lateral node dissection for advanced lower rectal cancerEur J Cancer3112291232CrossRef Moriya, Y, Sugihara, K, Akasu, T, Fujita, S 1995Nerve-sparing surgery with lateral node dissection for advanced lower rectal cancerEur J Cancer3112291232CrossRef
19.
Zurück zum Zitat Sugihara, K, Moriya, Y, Akasu, T, Fujita, S 1996Pelvic autonomic nerve preservation for patients with rectal carcinoma. Oncologic and functional outcomeCancer7818711880PubMedCrossRef Sugihara, K, Moriya, Y, Akasu, T, Fujita, S 1996Pelvic autonomic nerve preservation for patients with rectal carcinoma. Oncologic and functional outcomeCancer7818711880PubMedCrossRef
20.
Zurück zum Zitat Mori, T, Takahashi, K, Yasuno, M 1998Radial resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: impact of lateral lymph node dissectionLangenbecks Arch Surg383409415PubMedCrossRef Mori, T, Takahashi, K, Yasuno, M 1998Radial resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: impact of lateral lymph node dissectionLangenbecks Arch Surg383409415PubMedCrossRef
21.
Zurück zum Zitat Saito, N, Koda, K, Nobuhiro, K, et al. 1999Nerve-sparing surgery for advanced rectal cancer patients: special reference to Dukes C patientsWorld J Surg2310621068PubMedCrossRef Saito, N, Koda, K, Nobuhiro, K,  et al. 1999Nerve-sparing surgery for advanced rectal cancer patients: special reference to Dukes C patientsWorld J Surg2310621068PubMedCrossRef
22.
Zurück zum Zitat Morita, T, Murata, A, Koyama, M, Totsuka, E, Sasaki, M 2003Current status of autonomic nerve-preserving surgery for mid and lower rectal cancers: Japanese experience with lateral node dissectionDis Colon Rectum46S78S87PubMed Morita, T, Murata, A, Koyama, M, Totsuka, E, Sasaki, M 2003Current status of autonomic nerve-preserving surgery for mid and lower rectal cancers: Japanese experience with lateral node dissectionDis Colon Rectum46S78S87PubMed
23.
Zurück zum Zitat Parks, AG 1972Transanal technique in low rectal anastomosisProc R Soc Med65825826 Parks, AG 1972Transanal technique in low rectal anastomosisProc R Soc Med65825826
24.
Zurück zum Zitat Jorge, JM, Wexner, SD 1993Etiology and management of fecal incontinenceDis Colon Rectum367797PubMedCrossRef Jorge, JM, Wexner, SD 1993Etiology and management of fecal incontinenceDis Colon Rectum367797PubMedCrossRef
25.
Zurück zum Zitat Kirwan, WO, Turnbull RB, RB,Jr, Fazio, VW, Weakley, FL 1978Pullthrough operation with delayed anastomosis for rectal cancerBr J Surg65695698PubMed Kirwan, WO, Turnbull RB, RB,Jr, Fazio, VW, Weakley, FL 1978Pullthrough operation with delayed anastomosis for rectal cancerBr J Surg65695698PubMed
26.
Zurück zum Zitat Paty, PB, Enker, WE, Cohen, AM, Lauwers, GY 1994Treatment of rectal cancer by low anterior resection with coloanal anastomosisAnn Surg219365373PubMedCrossRef Paty, PB, Enker, WE, Cohen, AM, Lauwers, GY 1994Treatment of rectal cancer by low anterior resection with coloanal anastomosisAnn Surg219365373PubMedCrossRef
27.
Zurück zum Zitat Lazorthes, F, Fages, P, Chiotasso, P, Bugat, R 1986Synchronous abdominotrans-sphincteric resection of low rectal cancer: new technique for direct colo-anal anastomosisBr J Surg73573575PubMed Lazorthes, F, Fages, P, Chiotasso, P, Bugat, R 1986Synchronous abdominotrans-sphincteric resection of low rectal cancer: new technique for direct colo-anal anastomosisBr J Surg73573575PubMed
28.
Zurück zum Zitat McAnena, OJ, Heald, RJ, Lockhart-Mummery, HE 1990Operative and functional results of total mesorectal excision with ultra-low anterior resection in the management of carcinoma of the lower one-third of the rectumSurg Gynecol Obstet170517521PubMed McAnena, OJ, Heald, RJ, Lockhart-Mummery, HE 1990Operative and functional results of total mesorectal excision with ultra-low anterior resection in the management of carcinoma of the lower one-third of the rectumSurg Gynecol Obstet170517521PubMed
29.
Zurück zum Zitat Leo, E, Belli, F, Baldini, MT, et al. 1994New perspective in the treatment of low rectal cancer: total rectal resection and coloendoanal anastomosisDis Colon Rectum37S62S68PubMedCrossRef Leo, E, Belli, F, Baldini, MT,  et al. 1994New perspective in the treatment of low rectal cancer: total rectal resection and coloendoanal anastomosisDis Colon Rectum37S62S68PubMedCrossRef
30.
Zurück zum Zitat Rouanet, P, Fabre, JM, Dubois, JB, et al. 1995Conservative surgery for low rectal carcinoma after high-dose radiation. Functional and oncologic resultsAnn Surg2216773PubMedCrossRef Rouanet, P, Fabre, JM, Dubois, JB,  et al. 1995Conservative surgery for low rectal carcinoma after high-dose radiation. Functional and oncologic resultsAnn Surg2216773PubMedCrossRef
31.
Zurück zum Zitat Cavaliere, F, Pemberton, JH, Cosimelli, M, Fazio, VW, Beart, RW,Jr 1995Coloanal anastomosis for rectal cancer. Long-term results at the Mayo and Cleveland ClinicsDis Colon Rectum38807812PubMedCrossRef Cavaliere, F, Pemberton, JH, Cosimelli, M, Fazio, VW, Beart, RW,Jr 1995Coloanal anastomosis for rectal cancer. Long-term results at the Mayo and Cleveland ClinicsDis Colon Rectum38807812PubMedCrossRef
32.
Zurück zum Zitat Gamagami, R, Istvan, G, Cabarrot, P, Liagre, A, Chiotasso, P, Lazorthes, F 2000Fecal continence following partial resection of the anal canal in distal rectal cancer: long-term results after coloanal anastomosesSurgery127291295PubMedCrossRef Gamagami, R, Istvan, G, Cabarrot, P, Liagre, A, Chiotasso, P, Lazorthes, F 2000Fecal continence following partial resection of the anal canal in distal rectal cancer: long-term results after coloanal anastomosesSurgery127291295PubMedCrossRef
33.
Zurück zum Zitat Lewis, WG, Martin, IG, Williamson, ME, et al. 1995Why do some patients experience poor functional results after anterior resection of the rectum for carcinoma?Dis Colon Rectum38259263PubMedCrossRef Lewis, WG, Martin, IG, Williamson, ME,  et al. 1995Why do some patients experience poor functional results after anterior resection of the rectum for carcinoma?Dis Colon Rectum38259263PubMedCrossRef
34.
Zurück zum Zitat Karanjia, ND, Schache, DJ, Heald, RJ 1992Function of the distal rectum after low anterior resection for carcinomaBr J Surg79114116PubMed Karanjia, ND, Schache, DJ, Heald, RJ 1992Function of the distal rectum after low anterior resection for carcinomaBr J Surg79114116PubMed
35.
Zurück zum Zitat Williamson, ME, Lewis, WG, Finan, PJ, Miller, AS, Holdsworth, PJ, Johnston, D 1995Recovery of physiologic and clinical function after low anterior resection of the rectum for carcinoma: myth or reality?Dis Colon Rectum38411418PubMedCrossRef Williamson, ME, Lewis, WG, Finan, PJ, Miller, AS, Holdsworth, PJ, Johnston, D 1995Recovery of physiologic and clinical function after low anterior resection of the rectum for carcinoma: myth or reality?Dis Colon Rectum38411418PubMedCrossRef
36.
Zurück zum Zitat Paty, PB, Enker, WE, Cohen, AM, Minsky, BD, Friedlander-Klar, H 1994Long-term functional results of coloanal anastomosis for rectal cancerAm J Surg1679095PubMedCrossRef Paty, PB, Enker, WE, Cohen, AM, Minsky, BD, Friedlander-Klar, H 1994Long-term functional results of coloanal anastomosis for rectal cancerAm J Surg1679095PubMedCrossRef
37.
Zurück zum Zitat Graf, W, Ekstrom, K, Glimelius, B, Pahlman, L 1996A pilot study of factors influencing bowel function after colorectal anastomosisDis Colon Rectum39744749PubMedCrossRef Graf, W, Ekstrom, K, Glimelius, B, Pahlman, L 1996A pilot study of factors influencing bowel function after colorectal anastomosisDis Colon Rectum39744749PubMedCrossRef
38.
Zurück zum Zitat Milsom, JW, Ludwig, KA 1997Surgical management of rectal cancerWanedo, HJ eds. Surgery for gastrointestinal cancer: a multidisciplinary approachLippincott-RavenPhiladelphia635655 Milsom, JW, Ludwig, KA 1997Surgical management of rectal cancerWanedo, HJ eds. Surgery for gastrointestinal cancer: a multidisciplinary approachLippincott-RavenPhiladelphia635655
39.
Zurück zum Zitat Hallbook, O, Pahlman, L, Krog, M, Wexner, SD, Sjodahl, R 1996Randomized comparison of straight and colonic J-pouch anastomosis after low anterior resectionAnn Surg2245865PubMedCrossRef Hallbook, O, Pahlman, L, Krog, M, Wexner, SD, Sjodahl, R 1996Randomized comparison of straight and colonic J-pouch anastomosis after low anterior resectionAnn Surg2245865PubMedCrossRef
40.
Zurück zum Zitat Rullier, E, Goffre, B, Bonnel, C, Zerbib, F, Caudry, M, Saric, J 2001Preoperative radiochemotherapy and sphincter-saving resection for T3 carcinomas of the lower third of the rectumAnn Surg234633640PubMedCrossRef Rullier, E, Goffre, B, Bonnel, C, Zerbib, F, Caudry, M, Saric, J 2001Preoperative radiochemotherapy and sphincter-saving resection for T3 carcinomas of the lower third of the rectumAnn Surg234633640PubMedCrossRef
Metadaten
Titel
Intersphincteric Resection in Patients with Very Low Rectal Cancer: A Review of the Japanese Experience
verfasst von
Norio Saito, M.D.
Yoshihiro Moriya, M.D.
Kazuo Shirouzu, M.D.
Koutarou Maeda, M.D.
Hidetaka Mochizuki, M.D.
Keiji Koda, M.D.
Takashi Hirai, M.D.
Masanori Sugito, M.D.
Masaaki Ito, M.D.
Akihiro Kobayashi, M.D.
Publikationsdatum
01.10.2006
Erschienen in
Diseases of the Colon & Rectum / Ausgabe Sonderheft 1/2006
Print ISSN: 0012-3706
Elektronische ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-006-0598-y

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