Yang Zhanpeng, Wang Aizhen, Liang Hong, Fan Qingwen, Li Shuaipeng, Yao Fuqiang, Li Mengzhe, Wang Xi, Zhang Chao
Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, 450003, China.
Henan Provincial People's Hospital, Zhengzhou, Henan, 450003, China.
World J Surg Oncol. 2025 Jul 18;23(1):287. doi: 10.1186/s12957-025-03952-6.
Colorectal cancer remains a significant global health burden, with low rectal tumors posing unique surgical challenges due to their proximity to the anal verge. Traditional abdominoperineal resection (APR) compromises quality of life with permanent colostomy, while sphincter-preserving techniques like laparoscopic intersphincteric resection (L-ISR) face technical limitations. This study evaluates the safety and efficacy of a novel technique - ISR combined with rectal eversion and total extra-abdominal resection (ISRER) - aimed at reducing anastomotic complications, and enhancing anal preservation in anatomically challenging patients.
This was a prospective randomized controlled, unmasked, parallel group trial in Henan Provincial People's Hospital. Intraoperative peritoneal lavage cytology and bacterial culture were performed to assess tumor cell shedding and contamination. Outcomes included distal margin positivity, anal preservation rate, postoperative complications, hospital costs,30-day readmission rates and postoperative stay.
All 74 patients with low rectal cancer (3-5 cm from the anal verge) between March 2024 and March 2025. Patients were randomly stratified into ISRER (n = 35) and laparoscopic ISR (L-ISR) (n = 39) groups. No tumor cells or bacterial contamination were detected in peritoneal lavage cytology or cultures. Both groups achieved 100% R0 resection (distal margin negativity). The ISRER group demonstrated a significantly higher anal preservation rate (94.3 vs. 71.8%, P = 0.011) with comparable postoperative complications (2.9 vs. 2.6%, P = 0.735), 30-day readmission rates (2.9 vs. 2.6%, P = 0.938), and hospitalization costs (62,540 vs. 64,937 CNY, P = 0.915). Median postoperative stay was marginally longer in the ISRER group (10 vs. 9 days, P = 0.135), while gastrointestinal recovery and inflammatory markers showed no intergroup differences.
ISRER is a safe and technically feasible sphincter-preserving approach for low rectal cancer, offering superior anal retention without compromising oncological safety or increasing complications.
结直肠癌仍然是一项重大的全球健康负担，低位直肠肿瘤因其靠近肛缘而带来独特的手术挑战。传统的腹会阴联合切除术（APR）会因永久性结肠造口而影响生活质量，而诸如腹腔镜括约肌间切除术（L-ISR）等保留括约肌的技术面临技术限制。本研究评估了一种新技术——括约肌间切除术联合直肠外翻及全腹外切除术（ISRER）——的安全性和有效性，旨在减少吻合口并发症，并在解剖结构复杂的患者中提高肛门保留率。
这是一项在河南省人民医院进行的前瞻性随机对照、非盲、平行组试验。术中进行腹腔灌洗细胞学检查和细菌培养，以评估肿瘤细胞脱落和污染情况。观察指标包括远端切缘阳性率、肛门保留率、术后并发症、住院费用、30天再入院率和术后住院时间。
2024年3月至2025年3月期间，共纳入74例低位直肠癌患者（距肛缘3-5厘米）。患者被随机分层分为ISRER组（n = 35）和腹腔镜ISR组（L-ISR）（n = 39）。腹腔灌洗细胞学检查或培养均未检测到肿瘤细胞或细菌污染。两组均实现了100%的R0切除（远端切缘阴性）。ISRER组的肛门保留率显著更高（9丝3%对71.8%，P = 0.011），术后并发症（2.9%对2.6%，P = 0.735）、30天再入院率（2.9%对2.6%，P = 0.938）和住院费用（62540元对64937元，P = 0.915）相当。ISRER组的术后中位住院时间略长（10天对9天，P = 0.135），而胃肠道恢复情况和炎症指标在组间无差异。
ISRER是一种安全且技术上可行的低位直肠癌保留括约肌方法，在不影响肿瘤学安全性或增加并发症的情况下，能提供更好的肛门保留效果。
