Korea University Anam Hospital, Seoul, Korea.
Alexis Multispecialty Hospital, Nagpur, India.
Colorectal Dis. 2023 Sep;25(9):1896-1909. doi: 10.1111/codi.16704. Epub 2023 Aug 10.
Intersphincteric resection (ISR) is an oncologically complex operation for very low-lying rectal cancers. Yet, definition, anatomical description, operative indications and operative approaches to ISR are not standardized. The aim of this study was to standardize the definition of ISR by reaching international consensus from the experts in the field. This standardization will allow meaningful comparison in the literature in the future.
A modified Delphi approach with three rounds of questionnaire was adopted. A total of 29 international experts from 11 countries were recruited for this study. Six domains with a total of 37 statements were examined, including anatomical definition; definition of intersphincteric dissection, intersphincteric resection (ISR) and ultra-low anterior resection (uLAR); indication for ISR; surgical technique of ISR; specimen description of ISR; and functional outcome assessment protocol.
Three rounds of questionnaire were performed (response rate 100%, 89.6%, 89.6%). Agreement (≥80%) reached standardization on 36 statements.
This study provides an international expert consensus-based definition and standardization of ISR. This is the first study standardizing terminology and definition of deep pelvis/anal canal anatomy from a surgical point of view. Intersphincteric dissection, ISR and uLAR were specifically defined for precise surgical description. Indication for ISR was determined by the rectal tumour's maximal radial infiltration (T stage) below the levator ani. A new surgical definition of T3isp was reached by consensus to define T3 low rectal tumours infiltrating the intersphincteric plane. A practical flowchart for surgical indication for uLAR/ISR/abdominoperineal resection was developed. A standardized ISR surgical technique and functional outcome assessment protocol was defined.
肛门内括约肌间切除术（ISR）是一种针对非常低位直肠癌的具有挑战性的手术。然而，ISR 的定义、解剖描述、手术适应证和手术方法尚未标准化。本研究旨在通过该领域的国际专家达成国际共识来标准化 ISR 的定义。这种标准化将允许未来在文献中进行有意义的比较。
采用三轮问卷调查的改良 Delphi 方法。共招募了来自 11 个国家的 29 名国际专家参与本研究。共考察了 6 个领域的 37 项陈述，包括解剖定义；肛门内括约肌切开、ISR 和超低前切除术（uLAR）的定义；ISR 的适应证；ISR 的手术技术；ISR 标本描述；以及功能结局评估方案。
共进行了三轮问卷调查（应答率 100%、89.6%、89.6%）。36 项陈述达成了≥80%的一致性，从而实现了标准化。
本研究提供了基于国际专家共识的 ISR 定义和标准化。这是第一项从手术角度对深部骨盆/肛管解剖学进行术语和定义标准化的研究。肛门内括约肌切开、ISR 和 uLAR 被特别定义，以便进行精确的手术描述。ISR 的适应证取决于肛提肌下方直肠肿瘤的最大径向浸润（T 分期）。通过共识达成了新的 ISR 手术定义 T3isp，用于定义侵犯肛门内括约肌间平面的 T3 低位直肠肿瘤。开发了用于 uLAR/ISR/腹会阴切除术手术适应证的实用流程图。定义了标准化的 ISR 手术技术和功能结局评估方案。
