Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan.
J Surg Res. 2011 Sep;170(1):e93-8. doi: 10.1016/j.jss.2011.05.018. Epub 2011 Jun 7.
The intersphincteric resection technique has been used to extend the opportunity for sphincter preservation in patients with very low rectal cancer. The aim of this study is to assess the long-term oncological and functional outcomes of intersphincteric resection.
Patients with extraperitoneal rectal cancer were treated and retrospectively chart reviewed. The oncological and functional outcomes were evaluated. Comparisons of the overall disease-free survival and recurrence were analyzed for the different surgical procedures.
From July 2002 to August 2009, 162 patients with extraperitoneal rectal cancer were retrospectively chart reviewed. One-hundred one patients (62.3%) underwent low anterior resection, 26 patients (16%) received radical proctectomy and intersphincteric resection with coloanal anastomosis, and 23 (14.2%) had abdominoperineal resection. The sphincter preservation rate was 80%. In the intersphincteric resection group, overall survival rates at 3 and 5 y were 83% and 83%, and disease-free survival at 3 and 5 y were 82% and 76%, respectively. The mean stool frequency was 4.7 per 24 h. There were 38.1% of patients suffering from stool fragmentation, and 23.8% had nocturnal defecation. About one-third of the patients required antidiarrheal medications. Overall, 90.8% of patients were satisfied with the functional results of surgery.
Our data show intersphincteric resection for low rectal cancer is feasible and safe. Preoperative radiotherapy may negatively affect symptom-specific quality of life.
经括约肌间切除术已被用于为低位直肠癌患者保留括约肌功能。本研究旨在评估经括约肌间切除术的长期肿瘤学和功能结局。
对接受经腹直肠癌根治术的患者进行回顾性图表审查。评估了肿瘤学和功能结局。分析了不同手术方法的总体无病生存率和复发率的比较。
2002 年 7 月至 2009 年 8 月，回顾性图表审查了 162 例腹膜外直肠癌患者。101 例（62.3%）接受低位前切除术，26 例（16%）接受根治性直肠切除术和经括约肌间切除术联合结肠肛管吻合术，23 例（14.2%）行腹会阴切除术。保肛率为 80%。在经括约肌间切除术组中，3 年和 5 年的总生存率分别为 83%和 83%，3 年和 5 年的无病生存率分别为 82%和 76%。平均排便频率为 24 小时 4.7 次。有 38.1%的患者出现粪便碎片，23.8%的患者出现夜间排便。约三分之一的患者需要使用止泻药。总的来说，90.8%的患者对手术的功能结果满意。
我们的数据表明，经括约肌间切除术治疗低位直肠癌是可行和安全的。术前放疗可能会对特定于症状的生活质量产生负面影响。
