| Theme | Current Topics Relating to the Anus | |
|---|---|---|
| Title | Intersphincteric Resection for Lower Rectal Cancer | |
| Publish Date | 2010/01 | |
| Author | Yoshiki Kajiwara | Department of Surgery, National Defense Medical College |
| Author | Kazuo Hase | Department of Surgery, National Defense Medical College |
| Author | Hideki Ueno | Department of Surgery, National Defense Medical College |
| Author | Eiji Shinto | Department of Surgery, National Defense Medical College |
| Author | Yojiro Hashiguchi | Department of Surgery, National Defense Medical College |
| Author | Hidetaka Mochizuki | Department of Surgery, National Defense Medical College |
| [ Summary ] | Intersphincteric resection (ISR) is a surgical procedure for very low rectal cancer, which is used to be treated with abdominoperineal resection and permanent colostomy. A characteristic of ISR is the excision of all or part of the internal anal sphincter, because of the necessity to achieve a sufficient distal margins. ISR is an attempt to extend the indications for avoidance of permanent colostomy. ISR is performed in rectal cancer patients with the tumors situated less than 5 cm from the anal verge or at less than 3 cm from the dentate line. The criteria for exclusion of ISR are invasion of the external sphincter or levator ani, pooly differentiated tumors, or patients who are not fully continent preoperatively. Continence gradually improves becoming good or acceptable two years after the surgery in most patients treated with ISR, although, postoperative sphincter functionality is significantly reduced compared with preoperative functionality. Several studies have shown that ISR produces satisfactory long-term results in terms of functional and oncologic outcomes. However, ISR must be evaluated with prospective larger-scale studies, in particular those which may define exactly which tumors of the lower rectum are suitable for conservative surgery. | |