Short Term Efficacy of Total Mesorectal Resection and Intersphincter Resection for Ultra-Low Rectal Cancer and Anorectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHENG Fang ^1,2 , YANG Chuanhua ¹ , WANG Xiaodong ¹ , LI Li. ¹

1. Center of Gastrointestinal Surgery， West China Hospital， Sichuan University， Chengdu 610041， Sichuan Province， China;;
2. Department of Anorectal Surgical， People’s Hospital of Dianjiang County， Chongqing City， Chongqing 408300， China;

Corresponding author：

Keywords：

Ultra-low rectal cancer; Anorectal cancer; Total mesorectal excision; Intersphincter resection; Anal preserving surgery

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Objective 　To investigate the safety and feasibility of the total mesorectal excision （TME） and intersphincteric resection （ISR） for ultra-low rectal cancer and anal sphincter preservation surgery for anorectal cancer， and to evaluate the short term efficacy and postoperative anal function.
Methods 　A retrospective analysis of clinical and follow-up data of 86 cases with TME＋ISR for ultra-low rectal cancer and anorectal cancer from January 2009 to December 2010 in West China Hospital of Sichuan University were performed.
Results 　Eighty-six patients were successfully performed the operation， the lower edge of tumor from the anus was 1-5 cm （average 1.63cm）； tumor diameter was 2-7 cm （average 3.4cm）. The tumors were high differentiation in 4 cases， moderately differentiation in 60 cases，and poorly differentiation in 22 cases. The pTNM stages were stageⅠin 12 cases， stageⅡA in 11 cases， stage ⅡB in 15 cases， stage ⅢA in 2 cases， stage ⅢB in 23 cases， stage ⅢC in 16 cases， and stage Ⅳ in 7 cases. There were postoperative anastomotic leakage in 3 cases， perianal infection in 2 cases （1 case received reoperation with permanent colostomy because of pelvic peritoneal infection caused by perianal severe infections）. Anastomotic bleeding and anastomotic stenosis were of 2 cases respectively. Rectovaginal fistula， inflammatory ileus， urinary retention， and abdominal infection were of 1 case respectively. Eighty-six patients were followed-up for 12-24 months， the mean time was 18 months. Liver metastases was found in 1 case in 7 months after operation， 2 cases dead in the 7th month and 12th month after operation respectively. Local recurrence were found in 3 cases （3.5%） in 1 year after operation. The survival rate of 1-year was 97.7% （84/86）. The times of defecation was 1-5 times a day. The Kirwan’s score level on function of control defecation was 1-2 grade.
Conclusions 　TME＋ISR for low rectal cancer and anorectal cancer is a viable， safe， and radical operation type for preservation of anus. The short term efficacy is satisfactory.

Citation： ZHENG Fang,YANG Chuanhua,WANG Xiaodong,LI Li.. Short Term Efficacy of Total Mesorectal Resection and Intersphincter Resection for Ultra-Low Rectal Cancer and Anorectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(7): 753-756. doi: Copy

1.	王振军，梁小波，杨新庆，等. 经肛门内外括约肌肌间切除直肠的直肠癌根治术疗效评价 [J]. 中华胃肠外科杂志， 2006，9(2)：111-113.
2.	林谋斌，尹路. 低位直肠癌的内括约肌切除术：对2 厘米法则的挑战 [J]. 中华普通外科杂志， 2007， 22(1)：74-75.
3.	李立. 结直肠癌外科应用技术的规范与创新( 十五) [J]. 中国普外基础与临床杂志， 2008， 15(3)：215-217.
4.	Ito M， Saito N， Sugito M， et al. Analysis of clinical factors associated with anal function after intersphincteric resection for very low retal cancer [J]. Dis Colon Rectum， 2009， 52(1)：64-70.
5.	Steven D， Wexner Badma Bashankaev，王颢，等. 低位直肠癌保肛手术的现状与争议 [J]. 中华外科杂志， 2009， 47(13)：971-974.
6.	戴勇，姜金波，张晓明，等. 外翻脱出式内括约肌切除的直肠癌根治术 [J]. 中华外科杂志， 2006，44(9)： 628-630.
7.	Kirwan WO， Turnbull RB Jr， Fazio VW， et al. Pullthrough operation with delayed anastomosis for rectal cancer [J]. Br J Surg， 1978， 65(10)：695-698.
8.	魏广辉，王振军，高志刚，等. 经肛门切除内括约肌治疗超低位直肠癌的保肛手术47 例临床经验 [J]. 中华普外科手术学杂志( 电子版)， 2009， 3(2)：503-507.
9.	周振旭，郑晓风，宋华羽，等. 腹腔镜全直肠系膜切除术联合经肛门内括约肌切除术治疗超低位直肠癌 [J]. 中华胃肠外科杂志， 2011， 14(6)：440-442.
10.	王振军，万远廉，刘玉村，等. 一种切除部分齿状线和肛管全层的超低位保肛手术 [J]. 中华胃肠外科杂志， 2002， 5(2)：107-109.
11.	Schiessel R， Novi G， Holzer B， et al. Technique and long-term results of intersphincteric resection for low rectal cancer [J]. Dis Colon Rectum， 2005， 48(10)：1858-1865.
12.	Peeters KC， Stassen LP. Laparoscopic intersphincteric resection：a feasible technique or the treatment of choice for patients with low rectal cancer? [J]. Dig Surg， 2011， 28(5-6)： 410-411.
13.	杨雪菲，钟克力，朱畅，等. 全直肠系膜切除联合内括约肌切除术治疗低位直肠癌的临床研究 [J]. 中华腔镜外科杂志，2010， 3(5)： 31-34.
14.	Fujimoto Y， Akiyoshi T， Kuroyanagi H， et al. Safety and feasibility of laparoscopic intersphincteric resection for very low rectal cancer [J]. J Gastrointest Surg， 2010， 14(4)：645-650.
15.	胡康，王波，李平. 末端2 cm 直肠癌齿状线以远浸润的临床病理研究 [J]. 中华胃肠外科杂志， 2008， 11(1)： 44-46.
16.	Beirens K，Penninckx F； PROCARE. Defunctioning stoma and anastomotic leak rate after total mesorectal excision with coloanal anastomosis in the context of PROCARE [J]. Acta Chir Belg，2012， 112(1)：10-14.
17.	Garlipp B， Ptok H， Schmidt U， et al. Factors influencing the quality of total mesorectal excision [J]. Br J Surg， 2012， 99(5)：714-720.
18.	Shelygin YA， Vorobiev GI， Pikunov DY， et al. Intersphincteric resection with partial removal of external anal sphincter for low rectal cancer [J]. Acta Chir Iugosl， 2008， 55(3)：45-53.
19.	Leong QM， Son DN， Baek SJ， et al. Edematous and painful external hemorrhoids following intersphincteric resection for low rectal cancer [J]. J Korean Surg Soc， 2011， 81 Suppl 1：S39-S42.
20.	王自强，周总光. 直肠癌多学科综合治疗的策略 [J]. 中华消化外科杂志， 2010， 9(6)：401-404.
21.	Funahashi K， Shiokawa H， Teramoto T， et al. Clinical outcome of laparoscopic intersphincteric resection combined with transanal rectal dissection for t3 low rectal cancer in patients with a narrow pelvis [J]. Int J Surg Oncol， 2011， 2011：901574.
22.	Yamamoto S， Fujita S， Akasu T， et al. Short-term outcomes of laparoscopic intersphincteric resection for lower rectal cancer and comparison with open approach [J]. Dig Surg， 2011， 28(5-6)：404-409.
23.	刘畅，罗翼，汪晓东，等. 低位/ 超低位直肠癌吻合术后评估肛门功能的方法 [J]. 中国普外基础与临床杂志， 2010， 17(9)：910-913.
24.	Park JS， Choi GS， Jun SH， et al. Laparoscopic versus open intersphincteric resection and coloanal anastomosis for low rectal cancer： intermediate-term oncologic outcomes [J]. Ann Surg，2011， 254(6)：941-946.

1. 王振军，梁小波，杨新庆，等. 经肛门内外括约肌肌间切除直肠的直肠癌根治术疗效评价 [J]. 中华胃肠外科杂志， 2006，9(2)：111-113.
2. 林谋斌，尹路. 低位直肠癌的内括约肌切除术：对2 厘米法则的挑战 [J]. 中华普通外科杂志， 2007， 22(1)：74-75.
3. 李立. 结直肠癌外科应用技术的规范与创新( 十五) [J]. 中国普外基础与临床杂志， 2008， 15(3)：215-217.
4. Ito M， Saito N， Sugito M， et al. Analysis of clinical factors associated with anal function after intersphincteric resection for very low retal cancer [J]. Dis Colon Rectum， 2009， 52(1)：64-70.
5. Steven D， Wexner Badma Bashankaev，王颢，等. 低位直肠癌保肛手术的现状与争议 [J]. 中华外科杂志， 2009， 47(13)：971-974.
6. 戴勇，姜金波，张晓明，等. 外翻脱出式内括约肌切除的直肠癌根治术 [J]. 中华外科杂志， 2006，44(9)： 628-630.
7. Kirwan WO， Turnbull RB Jr， Fazio VW， et al. Pullthrough operation with delayed anastomosis for rectal cancer [J]. Br J Surg， 1978， 65(10)：695-698.
8. 魏广辉，王振军，高志刚，等. 经肛门切除内括约肌治疗超低位直肠癌的保肛手术47 例临床经验 [J]. 中华普外科手术学杂志( 电子版)， 2009， 3(2)：503-507.
9. 周振旭，郑晓风，宋华羽，等. 腹腔镜全直肠系膜切除术联合经肛门内括约肌切除术治疗超低位直肠癌 [J]. 中华胃肠外科杂志， 2011， 14(6)：440-442.
10. 王振军，万远廉，刘玉村，等. 一种切除部分齿状线和肛管全层的超低位保肛手术 [J]. 中华胃肠外科杂志， 2002， 5(2)：107-109.
11. Schiessel R， Novi G， Holzer B， et al. Technique and long-term results of intersphincteric resection for low rectal cancer [J]. Dis Colon Rectum， 2005， 48(10)：1858-1865.
12. Peeters KC， Stassen LP. Laparoscopic intersphincteric resection：a feasible technique or the treatment of choice for patients with low rectal cancer? [J]. Dig Surg， 2011， 28(5-6)： 410-411.
13. 杨雪菲，钟克力，朱畅，等. 全直肠系膜切除联合内括约肌切除术治疗低位直肠癌的临床研究 [J]. 中华腔镜外科杂志，2010， 3(5)： 31-34.
14. Fujimoto Y， Akiyoshi T， Kuroyanagi H， et al. Safety and feasibility of laparoscopic intersphincteric resection for very low rectal cancer [J]. J Gastrointest Surg， 2010， 14(4)：645-650.
15. 胡康，王波，李平. 末端2 cm 直肠癌齿状线以远浸润的临床病理研究 [J]. 中华胃肠外科杂志， 2008， 11(1)： 44-46.
16. Beirens K，Penninckx F； PROCARE. Defunctioning stoma and anastomotic leak rate after total mesorectal excision with coloanal anastomosis in the context of PROCARE [J]. Acta Chir Belg，2012， 112(1)：10-14.
17. Garlipp B， Ptok H， Schmidt U， et al. Factors influencing the quality of total mesorectal excision [J]. Br J Surg， 2012， 99(5)：714-720.
18. Shelygin YA， Vorobiev GI， Pikunov DY， et al. Intersphincteric resection with partial removal of external anal sphincter for low rectal cancer [J]. Acta Chir Iugosl， 2008， 55(3)：45-53.
19. Leong QM， Son DN， Baek SJ， et al. Edematous and painful external hemorrhoids following intersphincteric resection for low rectal cancer [J]. J Korean Surg Soc， 2011， 81 Suppl 1：S39-S42.
20. 王自强，周总光. 直肠癌多学科综合治疗的策略 [J]. 中华消化外科杂志， 2010， 9(6)：401-404.
21. Funahashi K， Shiokawa H， Teramoto T， et al. Clinical outcome of laparoscopic intersphincteric resection combined with transanal rectal dissection for t3 low rectal cancer in patients with a narrow pelvis [J]. Int J Surg Oncol， 2011， 2011：901574.
22. Yamamoto S， Fujita S， Akasu T， et al. Short-term outcomes of laparoscopic intersphincteric resection for lower rectal cancer and comparison with open approach [J]. Dig Surg， 2011， 28(5-6)：404-409.
23. 刘畅，罗翼，汪晓东，等. 低位/ 超低位直肠癌吻合术后评估肛门功能的方法 [J]. 中国普外基础与临床杂志， 2010， 17(9)：910-913.
24. Park JS， Choi GS， Jun SH， et al. Laparoscopic versus open intersphincteric resection and coloanal anastomosis for low rectal cancer： intermediate-term oncologic outcomes [J]. Ann Surg，2011， 254(6)：941-946.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Short Term Efficacy of Total Mesorectal Resection and Intersphincter Resection for Ultra-Low Rectal Cancer and Anorectal Cancer

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