Objective To assess the anal sphincteric function after intersphincteric resection for low rectal cancer by vectorial manometry. Methods Maximal anal pressure, vector volume, vector symmetric index and rectal anal inhibitory reflex were assessed in 16 patients underwent intersphincteric resection for low rectal cancer from 1999 to 2006. Thirty patients with low anterior resection for rectal cancer and another 30 healthy individuals were selected as control. Results The patients in intersphincteric resection group were subdivided into soiling group and defecation function good group. Maximal pressure, vector volume and vector symmetric index of the patients in soiling group and defecation function good group were significantly lower than those of the healthy and low anterior resection controls (P＜0.001). The maximal systole pressure, systole vector volume and vector symmetric index in soiling group were significantly lower than those in function good group (P＜0.001). The 25.0% patients in intersphincteric resection group had rectal anal inhibitory reflex， was significantly lower than that of the low anterior resection control group (93.3%, P＜0.001). Conclusion The maximal pressure and vector volume are compromised in patients underwent intersphincteric resection . The vectorial manometry can be an objective comprehensive tool for the evaluation of anal sphincter function in patients with intersphincteric resection.
目的总结陈旧性会阴肛管缺损肛门不全失禁临床处理经验。方法回顾性分析我院1994年1月至2000年1月收治的7例陈旧性会阴肛管缺损肛门不全失禁患者的临床资料。结果7例患者均行手术治疗，术后全部随访，无一例复发。结论对于陈旧性会阴肛管缺损肛门不全失禁患者，明确找到断裂的外括约肌断端是手术成败的关键。
Objective To determine the oncological outcomes following the intersphincteric resection (ISR) for lower rectal cancer and influencing factors. Methods Reviewed the reports on ISR for lower rectal cancer, and summarized the oncological outcomes and influencing factors. The oncological outcomes included local and distant recurrence rates, postoperative survival, and mortality rates. Tumor indicators, surgical techniques, and perioperative radiochemotherapy were included in the influencing factors. Results The recurrence, survival, and mortality rates following ISR resemble traditional operations. Higher stages, metastasis, and non-standard operations affect the oncological outcomes significantly. Preoperative radiochemotherapy could improve the efficacy, but probably at the cost of postoperative anal function. Conclusions The oncological outcomes following ISR are acceptable. The careful case selection and rational arrangements of radiochemotherapy will allow better outcomes.
ObjectiveTo observe and assess the therapeutic effect of posterior amputation of internal sphincter and partial external sphincter in the treatment of old anal fissure. MethodsEighty patients with old anal fissure treated between August 2012 and June 2014 were randomly divided into study group and control group with 40 in each. The study group received posterior amputation of internal sphincter and partial external sphincter, while the control group underwent single amputation of internal sphincter. Then we observed the cure rate, wound healing days, pain at defecation after operation, defecation control after operation, and long-term recurrence rate. ResultsAll the 40 patients in study group were healed with a recovery rate of 100%, while 38 in control group were healed with a recovery rate of 95%; the difference between the two groups were not significant (P>0.05). The wound healing time in study group[(17.0±3.5) days] was much longer than that in the control group[(10.5±3.8) days] (P<0.05). The pain extents of fundament during defecating on the first day and 3, 7, and 15 days later in study group were more alleviated than those in the control group (P<0.05). In the six-month follow-up period, one patient in study group had liquid stools out of control 3 months after the surgery, and the others had no similar symptoms (P>0.05). ConclusionPosterior amputation of internal sphincter and partial external sphincter is a reasonable method for the treatment of old anal fissure. It can not only cure old anal fissure but also alleviate pain at defecation after operation and facilitate defecation.
ObjectiveTo compare anal function and quality of life between partial longitudinal resection of the anorectum and sphincter (PLRAS) and intersphincteric resection (ISR) for rectal cancer. MethodsNinety-nine cases of very low rectal cancer were classified as PLRAS group (n=23) and ISR group (n=76) according to different surgical method. Anal function was assessed by Saito function questionnaire and the Wexner scale in 6, 12, and 24 months after operation. At the same time, quality of life was assessed by European Organization for research and treatment of cancer quality of life questionnaire CR29 (EORTC-QLQ-CR29). Results①Anastomosis stenosis:compared with ISR group, the situation on anastomosis stenosis was worse in 6 months (P < 0.001) and 12 months (P=0.003) after operation, but didn't significantly differed in 24 months after operation (P=0.230).②Results of the Saito function questionnaire:compared with ISR group, there were higher incidence on stool fragmentation (P=0.016), dyschesia (P=0.008), and feces-flatus discrimination (P < 0.001) in PLRAS group in 6 months after operation, and the incidence of feces-flatus discrimination was still higher in 12 months (P=0.017), but there was no any significant difference in 24 months after operation (P > 0.05).③Results of Wexner scale:there were no statistical difference between the 2 groups at all recorded times (P > 0.05).④Results of EORTC-QLQ-CR29 questionnaire:in 6 months after operation, the scores of flatulence (P=0.003), faecal incontinence (P=0.043), and sexual interest in women (P=0.023) of PLARS group were lower than ISR group but higher in buttock pain (P=0.031) and dyspareunia (P=0.006). In 12 months after operation, the scores of flatulence (P=0.012) and sexual interest in women (P=0.017) were both lower than ISR group, but score of dyspareunia was higher (P=0.012). In 24 months after operation, there was no any significant difference (P > 0.05). ConclusionsPLRAS surgery have worse situation of anastomosis stenosis and sexual function in women than ISR surgery before 12 months after operation, but have analogous effect in 24 months after operation.
ObjectiveTo analyze the safety and feasibility of laparoscopic intersphincteric resection with stapled colo-anal anastomosis under direct vision for low rectal cancer. MethodsFrom January 2001 to March 2012, 138 patients were underwent intersphincteric resection for low rectal cancer, 45 cases of whom were received laparoscopic surgery and stapled colo-anal anastomosis (SCAA group), and the other 93 cases (55 open and 38 laparoscopic) of whom were received hand-sewn colo-anal anastomosis (HCAA group). The morbidity comparison only involed the data of relevant to the anastomosis. The anus functional outcomes, including those from the Saito function questionnaire and Wexner score, were compared and only involved the data of relevant to the laparoscope. Results①The anastomotic complications rates were similar for the fistula, bleeding, and rectal mucosal prolapse (P > 0.05); the rate of anastomosis leakage and the degree of anastomotic stricture in the SCAA group were significantly lower (or milder) than those in the HCAA group (P=0.001 and P=0.022, respectively).②As for the functional results, the incidence of dyschesia in the SCAA group was significantly lower than that in the HCAA group (P=0.016), and the other 7 items of Saito function questionnaire and Wexner score were similar between these two groups (P > 0.05). ConclusionsCompared with traditional intersphincteric resection for low rectal cancer, laparoscopic surgery with stapled colo-anal anastomosis could reduce the morbidity and the anus function is non-inferior to the former.
ObjectiveThe low anterior resection syndrome (LARS) score is a simple and visual instrument assessing sphincter preserving surgery for low rectal cancer. The purpose of this study is to analyze the feasibility of using LARS score to assess the function after intersphincteric resection for low rectal cancer. MethodsBetween March 2013 and June 2015, 76 patients underwent sphincter preserving surgery for low rectal cancer, 23 cases underwent intersphincteric resection set as ISR group, the other 53 cases received low anterior resection set as LAR group. LARS score, Saito function questionnaire, Wexner score, and European organization for research and treatment of cancer (EORTC) quality of life questionnaire core 30 (QLQ-C30), questionnaire module for colorectal cancer (QLQ-CR29) were compared for the two groups. ResultsThere were 63.2 percent patients (48/76) appeared major LARS, 27.6 percent (21/76) minor LARS and 9.2 percent (7/76) no LARS, there were no statistically difference between the ISR and LAR groups (P=0.727), but the item of incontinence due to liquid stools appeared more obvious in ISR group (P=0.009). The items of faecel incontinence and sore skin for EORTC QLQ-CR29 were serious in ISR group (P < 0.05), the other item of EORTC QLQ-CR29 and EORTC QLQ-C30, Saito function questionnaire, Wexner score were similar between the two groups (all P > 0.05). ConclusionThe anal function after intersphincteric resection is non-inferior to the low anterior resection for low rectal cancer, but both can appear serious low anterior resection syndrome.
Objective To discuss whether age has an influence on short-term effect of intersphincteric resection (ISR) for elderly (≥75 years old) patients with ultra-low rectal or canal cancer or not. Methods From February 2016 to February 2017, 196 patients with ultra-low rectal or canal cancer received ISR in the Gastrointestinal Surgery Center of West China Hospital were eligible to include in this study, then they were divided into ≥75 years old group and <75 years old group according to the patients’ age. The intraoperative index, postoperative index, and complications rate were compared between these two groups. Results There were 113 cases in the ≥75 years old group, 83 cases in the <75 years old group, the baselines such as the gender composition, body mass index, tumor histology type, differentiation degree, tumor size, and distance from the anal margin had no significant differences ( P>0.05), but the preoperative anaesthetized ASA grade, proportions of pulmonary insufficiency, hypoproteinemia, anemia, hypertension, diabetes, and cardiac insufficiency of the ≥75 years old group were significantly higher than those of the <75 years old group (P<0.05). The operative time, intraoperative bleeding, and total complications rate had no differences between these two groups (P>0.05), the first exhaust time, the first eating time, the first defecation time, the first ambulation time, and hospitalization time of the ≥75 years old group were significantly longer than those of the <75 years old group (P=0.023, 0.037, 0.019, 0.020, and 0.012, respectively). There were no significant differences in the incidences of the anastomotic leakage, perianal infection, intestinal obstruction, and wound infection between these two groups (P>0.05). All the 196 patients were followed-up with an average follow-up of 7 months, there were 4 cases of recurrent patients, of which 3 were in the ≥75 years old group and 1 in the <75 years old group; there were 3 cases of death, of which 2 were in the ≥75 years old group and 1 in the <75 years old group. Conclusions Short-term recovery of elderly patients with ultra-low rectal or canal cancer is slower than younger patients because of poor preoperative conditions. ISR surgery is still safe and effective for elderly patients with ultra-low rectal or canal cancer and postoperative complications rate has no obvious increase, but it needs a surgeon’s skilled operation technology and multi-disciplinary team cooperation.
ObjectiveBased on the latest version of the Database from Colorectal Cancer(DACCA), this study analyzed the long-term effect of neoadjuvant therapy combined with intersphincteric resection (ISR) in patients with rectal cancer. MethodsAccording to the established screening criteria, clinical data of 944 patients with rectal cancer admitted from January 2009 to December 2020 were collected from the DACCA updated on March 21, 2022, to explore the influencing factors for overall survival (OS) and disease specific survival (DSS) of rectal cancer treated with neoadjuvant therapy combined with ISR, by Cox proportional hazard regression model. Results① The 3-year OS and DSS survival rates of neoadjuvant therapy combined with ISR for rectal cancer were 89.2% and 90.4%, respectively, and the 5-year OS and DSS survival rates were 83.9% and 85.4%, respectively. ② For different ISR surgical methods and neoadjuvant therapy plans, there were no significant differences in OS and DSS (P>0.05), but there were significant differences in OS and DSS among different ypTNM stage groups (P<0.001), patients with ypTNM 0–Ⅱ had better OS and DSS. ③ BMI, ypTNM stage and R0 resection were influencing factors for OS and DSS (P<0.05). ④ The overall incidence of postoperative complications was low, including 6.4% (60/944) within 30 days, 7.5% (71/944) within half a year and 3.3% (31/944) over half a year after operation. ConclusionsIn the comprehensive treatment of patients with low/ultra-low rectal cancer, neoadjuvant therapy combined with ISR can achieve relatively stable and good long-term oncological efficacy, and the incidence of short-term postoperative complications is not high, which is one of the options.