Department of General Surgery Maslak Acibadem Hospital Istanbul, Turkey.
Department of General Surgery Ilhan Varank Sancaktepe Training and Research Hospital Istanbul, Turkey.
Surg Technol Int. 2021 Oct 26;39:166-172. doi: 10.52198/21.STI.39.CR1460.
The development of new surgical techniques and devices, as well as the improvements in neoadjuvant chemoradiotherapy enabled intersphincteric resection (ISR), has reduced permanent colostomy usage. The aim of this study was to assess the long-term oncological and functional outcomes of patients who underwent partial ISR for rectal cancer located less than 5cm from the anal verge.
A series of 106 consecutive patients with very low rectal cancer underwent curative partial ISR from January 2006 to September 2019 were retrospectively evaluated. One-hundred-three (97%) of 106 patients received neoadjuvant chemo-radiotherapy. Overall survival (OS), disease-free survival (DFS), and local recurrence (LR) rates were calculated using Kaplan-Meier methods. The Wexner incontinence score and Kirwan classification were used to evaluate patients' functional results.
The median follow up was 60 months (range, 18-174). The estimated five-year overall and disease-free survival rates were 89% and 81.6%, respectively. Five-year local recurrence and distant metastasis rates were 6.6% and 10.4%, respectively. There was no in-hospital and 30-day mortality. The median Wexner score was 9 (range, 0-20) for 72 patients. Age (<65 years, p=0.027) and gender (male, p=0.019) had a positive effect on functional outcomes after surgery. One and five years colostomy-free survival rates were 96% and 89%, respectively.
Intersphincteric resection techniques are feasible for patients with very low rectal cancer, providing good oncological and functional outcomes.
新的手术技术和设备的发展，以及新辅助放化疗的改进，使得经肛门内括约肌切除术（ISR）得以实现，从而降低了永久性结肠造口术的使用。本研究旨在评估距肛缘小于 5cm 的低位直肠癌患者接受部分 ISR 的长期肿瘤学和功能结局。
回顾性评估了 2006 年 1 月至 2019 年 9 月期间，106 例连续接受低位直肠癌根治性部分 ISR 的患者。106 例患者中有 103 例（97%）接受了新辅助化疗放疗。采用 Kaplan-Meier 方法计算总生存（OS）、无病生存（DFS）和局部复发（LR）率。采用 Wexner 失禁评分和 Kirwan 分类评估患者的功能结果。
中位随访时间为 60 个月（范围 18-174）。估计 5 年总生存率和无病生存率分别为 89%和 81.6%。5 年局部复发和远处转移率分别为 6.6%和 10.4%。无院内和 30 天死亡率。72 例患者的中位 Wexner 评分是 9 分（范围 0-20）。年龄（<65 岁，p=0.027）和性别（男性，p=0.019）对术后功能结果有积极影响。1 年和 5 年无结肠造口术生存率分别为 96%和 89%。
肛门内括约肌切除术技术适用于低位直肠癌患者，可提供良好的肿瘤学和功能结局。
