Analysis of Clinical Factors Associated with Anal Function after Intersphincteric Resection for Very Low Rectal Cancer

Department of Colorectal and Pelvic Surgery, National Cancer Center Hospital East, Chiba, Japan.
Diseases of the Colon & Rectum (Impact Factor: 3.2). 01/2009; 52(1):64-70. DOI: 10.1007/DCR.0b013e31819739a0
Source: PubMed

ABSTRACT The purpose of this study was to identify factors that have a negative impact on anal function after intersphincteric resection.
We evaluated postoperative anal function in 96 patients with very lower rectal cancer who underwent intersphincteric resection by having patients fill out detailed questionnaires at 3, 6, 12, and 24 months after surgery. Univariate and multivariate analysis based on the Wexner incontinence score were used to identify factors associated with poor anal function after intersphincteric resection.
The mean Wexner score at 12 months after stoma closure was 10.0. Patients with frequent major soiling showed a Wexner score of >or=16, and this score was used as a cutoff value of poor anal function. In the univariate analysis, poor anal function was significantly associated with a greater extent of excision of the internal sphincter and with preoperative chemoradiotherapy. In the multivariate analysis, preoperative chemoradiotherapy was the only independent factor associated with poor anal function after intersphincteric resection (odds ratio=10.3; 95 percent confidence interval, 2.3-46.3, P < 0.01).
Preoperative chemoradiotherapy was identified as the risk factor with the greatest negative impact on anal function after intersphincteric resection, regardless of extent of excision of the internal sphincter.

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    • "These results suggested that anal function may improve gradually to a satisfactory level, even if anal dysfunction is evident immediately following stoma closure. However, the authors [7] found that postoperative anal function of the 40 patients who had received preoperative CRT was severely impaired, regardless of the type of ISR. In addition, multivariate analysis demonstrated that preoperative CRT was the only independent factor associated with poor anal function after ISR, which was consistent with a prior study on the longterm functional results [8]. "
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    ABSTRACT: Operating on low rectal cancer by performing an intersphincteric resection (ISR) with coloanal anastomosis has been adopted as an alternative to abdominoperineal excision (APE) following Schiessel et al. report in 1994, as it preserves the sphincter and avoids the need for a permanent stoma. We undertook a review of the recent literature specifically focusing on long-term oncologic and functional outcomes of ISR to evaluate whether this operation is a valid alternative to an APE. In conclusion, younger patients with T1 or T2 rectal cancers who require no preoperative therapy are ideal candidates for ISR, given that preoperative chemoradiotherapy may cause long-term severe anal dysfunction after ISR.
    08/2012; 2012:585484. DOI:10.5402/2012/585484
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    • "Trabalho apresentdo à Academia de Medicina do Rio de janeiro para concorrer à Membro Titular. Recebido em 16/07/2009 Aceito para publicação em 28/08/2009 INTRODUÇÃO "
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    ABSTRACT: PURPOSES: The main purpose of this study was to evaluate the postoperative complications, the length of the hospital stay, the clinic functional results, and the oncological outcome at 2,5 years follow-up of patients with very low rectal cancer treated by laparoscopic coloanal anastomosis and intersphincteric resection. PATIENTS AND METHODS: 491 patients were treated by laparoscopic colorectal surgery, 13 of 172 with rectal cancer were selected and prospectively evaluated. All with very low rectal cancer, 9 female. No patient T4 or with complete response to quimioirradiation was selected. Quimioirradiation was used in 8 patients. RESULTS: The postoperative complication rate was 23,1% and the anastomotic fistulas rate was 7,7%. No patients died postoperatively. 61,5% of the patients were discharged before 7 days of hospital stay. The median number of harvested lymphnodes was 13. Mean distal tumor-free margin was 1,5 cm. Circumferential margin was positive in 1 case (7,7%). Fecal incontinence was related in 41% of the patients and fracionned evacuations in 91%. Eleven patients (84%) have related good quality of life. One patient is with definitive stoma (7,7%). With median follow-up of 30 months, there were one local recurrence (7,7%) and two cases of lung metastases (15,4 %). All, the three patients died of the diseases. Ten patients are survived (77%) without disease. CONCLUSIONS: Analysis of results led to the following conclusions: a) The technique employed is safe and have presented low rate of complication and no mortality; b) The use of this technique have permited short length of the hospital stay; c) Functional results were regular , but colostomy was avoid in 92,3% of the patients; d) The use of this technique does not compromise the oncological outcome at a median follow-up of 30 months.
    Revista Brasileira de Coloproctologia 09/2009; 29(3):314-324.
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    ABSTRACT: The author present the laparoscopic coloanal anastomosis and intersphincteric resection technique to treat patients with very low rectal cancer. The operative steps are: 1 - Patient positioning; 2 - Instruments and equip positioning; 3 - Insertion of the ports; 4 - Preparation of the operative field; 5 - Difining and dividing the inferior mesenteric artery and vein by the medial approach; 6 - Mobilization of splenic flexure and sigmoid colon; 7 - rectal mobilization and total mesorectum excision by Rullier technique; 8 - Rectal division and coloanal anastomosis; 9 - intersphincteric resection and coloanal anastomosis by coloplasty, J pouch or latero-to-end techniques. The technique employed is safe and have presented low rate of complication and no mortality.
    Revista do Colégio Brasileiro de Cirurgiões 10/2009; 36(5):459-65.
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