First General Surgery, Haydarpasa Numune Research Training Hospital, Istanbul, Turkey.
Dis Colon Rectum. 2009 Nov;52(11):1895-901. doi: 10.1007/DCR.0b013e3181b55507.
Patients with very low rectal cancer were treated by intersphincteric rectal resection employing partial internal anal sphincter resection. They then underwent smooth muscle plasty to restore internal anal sphincter function. We assessed the functional and oncological outcomes.
Patients were selected if their biopsies revealed well-differentiated or moderately well-differentiated very low rectal tumors with distal tumor margins that permitted preservation of part of the internal anal sphincter. Functional results after closing the loop ileostomy were assessed by use of a standardized questionnaire. Continence was evaluated by use of the Kirwan score.
Forty-seven patients with T2 to T3 very low rectal carcinomas underwent intersphincteric rectal resection and smooth muscle plasty that extended into the anal canal. All received neoadjuvant treatment. Postoperative morbidity was 38.3%. There were 46 R0 resections based on frozen section analysis; one patient achieved an R0 resection after reexcision of a positive distal margin on the frozen section. The median follow-up period was 67.2 months. One patient had local recurrence. The five-year overall and disease-free survival rates were 85% and 82%, respectively. Six months, one year, and two years after intersphincteric rectal resection, 80%, 87%, and 89%, respectively, had good continence (Kirwan I and II). Evacuation difficulty was detected in two patients with colonic S-pouches.
Providing neodjuvant treatment and preserving at least half of the functional internal anal sphincter mass produces acceptable oncological and functional outcomes in patients undergoing intersphincteric rectal resection for very low rectal cancer. However, whether smooth muscle plasty further improves postoperative continence should be tested by further studies.
采用经肛门内括约肌部分切除的经肛门直肠切除术治疗非常低位直肠癌患者，然后进行平滑肌成形术以恢复内肛门括约肌功能。我们评估了功能和肿瘤学结果。
如果活检显示分化良好或中度分化的非常低位直肠肿瘤，且远端肿瘤边缘允许保留部分内肛门括约肌，则选择患者。通过使用标准化问卷评估关闭回肠造口术后的功能结果。通过使用 Kirwan 评分评估控便能力。
47 例 T2 至 T3 非常低位直肠癌患者接受经肛门直肠切除术和延伸至肛管的平滑肌成形术。所有患者均接受新辅助治疗。术后发病率为 38.3%。根据冷冻切片分析，有 46 例 R0 切除；1 例患者在冷冻切片上发现远端边缘阳性后进行再次切除，实现了 R0 切除。中位随访时间为 67.2 个月。1 例患者发生局部复发。五年总生存率和无病生存率分别为 85%和 82%。经肛门直肠切除术后 6 个月、1 年和 2 年，分别有 80%、87%和 89%的患者具有良好的控便能力（Kirwan I 和 II）。两名患者的结肠 S 袋出现排空困难。
在接受非常低位直肠癌经肛门直肠切除术的患者中，提供新辅助治疗并保留至少一半的功能性内肛门括约肌质量可产生可接受的肿瘤学和功能学结果。然而，平滑肌成形术是否能进一步提高术后控便能力，应通过进一步研究来检验。
