Yan Sen, Zhou Minwei, Zhou Yiming, Zhou Zhongwen, Tan Deyan, Li Zhenyang, Ding Jianhua, Xiang Jianbin
Department of General Surgery, Huashan Hospital Affiliated to Fudan University, Shanghai, China.
Department of Pathology, Huashan Hospital Affiliated to Fudan University, Shanghai, China.
Int J Surg. 2025 Jul 1;111(7):4434-4442. doi: 10.1097/JS9.0000000000002487. Epub 2025 May 12.
The precise anatomical plane and the pathological significance of circumferential resection margin integrity for ultralow rectal cancer remain inadequately defined. This article investigates the spatial architecture of the intersphincteric complex (ISC) and its clinical implications in intersphincteric space dissection for ultra-low rectal cancer.
Formalin-fixed hemipelvis specimens ( n = 37) from the laboratory of applied surgical anatomy were analyzed by macroscopic dissection and multiplexed immunofluorescence to characterize anatomical features of the ISC. Additionally, patients diagnosed with ultra-low rectal cancer ( n = 221) between 2019 and 2024 were enrolled prospectively. Primary endpoints for the patient group included disease free survival, local recurrence free survival and overall survival. Secondary endpoints involved the assessment of anorectal function using prospective questionnaires.
Anatomy and histologic research introduced the concept of the intersphincteric complex. Proportion of patients with tumor metastasis in the intersphincteric complex was 61/197 (30.96%), indicating that the intersphincteric complex represented a potential site for metastasis in ultra-low rectal cancer. Complete intersphincteric complex excision was associated with favorable disease-free survival (HR, 0.382 [95% CI, 0.187-0.781]; P = 0.008) and local recurrence-free survival (HR, 0.251 [95% CI, 0.085-0.741]; P = 0.012) in patients and no significant differences was found among three subgroups concerning Wexner scores and LARS scores.
A systematic anatomical analysis of the intersphincteric complex clearly elucidated key structures facilitating for ultralow rectal cancer. The intersphincteric complex is frequently a site for tumor metastasis and complete intersphincteric complex excision conferring favorable prognosis in patients with ultralow rectal cancer.
超低位直肠癌环周切缘完整性的确切解剖平面及病理意义仍未明确界定。本文研究了括约肌间复合体（ISC）的空间结构及其在超低位直肠癌括约肌间间隙解剖中的临床意义。
对应用外科解剖实验室的37例福尔马林固定的半骨盆标本进行宏观解剖和多重免疫荧光分析，以表征ISC的解剖特征。此外，前瞻性纳入了2019年至2024年间诊断为超低位直肠癌的221例患者。患者组的主要终点包括无病生存期、无局部复发生存期和总生存期。次要终点涉及使用前瞻性问卷评估肛门直肠功能。
解剖学和组织学研究引入了括约肌间复合体的概念。括约肌间复合体中发生肿瘤转移的患者比例为61/197（30.96%），表明括约肌间复合体是超低位直肠癌潜在的转移部位。完整切除括约肌间复合体与患者良好的无病生存期（HR，0.382[95%CI，0.187 - 0.781]；P = 0.008）和无局部复发生存期（HR，0.251[95%CI，0.085 - 0.741]；P = 0.012）相关，且三个亚组在Wexner评分和LARS评分方面未发现显著差异。
对括约肌间复合体进行系统的解剖学分析清楚地阐明了有助于超低位直肠癌手术的关键结构。括约肌间复合体常为肿瘤转移部位，完整切除括约肌间复合体可使超低位直肠癌患者获得良好预后。
