Analysis of Clinical Factors Associated with Anal Function after Intersphincteric Resection for Very Low Rectal Cancer
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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ABSTRACT: Laterally spreading tumors (LST) have been recognized worldwide. The aim of our retrospective study was to evaluate the clinicopathological differences of LST arising in the colon and rectum. We investigated the clinical records of consecutive patients with LST that were endoscopically or surgically resected at our hospital between February 2006 and March 2011. LST were classified into three types: granular-homogenous (LST-GH), granular-nodular mixed (LST-GM), and nongranular (LST-NG) types. We also defined the hardly elevated flat lesion with a dilated pit pattern that occurs at the margins of LST as the "skirt." The clinicopathological characteristics of the LST arising in the colon and rectum, including the presence of the skirt, were compared. A total of 496 colorectal LST in 435 patients were examined. LST-GM was predominant in the rectum, whereas LST-NG was predominant in the colon (p < 0.001). The mean tumor size was larger in the rectum (39.3 +/- 17.9 mm) than the colon (25.8 +/- 13.6 mm) (p < 0.001). Low-grade dysplasia frequency was lower in the rectum than the colon (4 vs. 37 %, p < 0.001). The skirt was identified in 15 lesions (3.0 %), with a higher incidence in the rectum than the colon (17 vs. 0.5 %, p < 0.001). The skirt was found only in LST-GM. A greater proportion of LST-GM, greater mean size, and lower incidence of low-grade dysplasia were found in rectal LST. The skirt was a novel and unique finding, primarily observed in rectal LST-GM cases.International Journal of Colorectal Disease 07/2014; 29(9). DOI:10.1007/s00384-014-1931-x · 2.42 Impact Factor
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ABSTRACT: As an anus-preserving surgery for very low rectal cancer, intersphincteric resection (ISR), has advanced markedly over the last 20 years. We investigated long-term oncologic, functional, and quality of life (QOL) outcomes after ISR with or without partial external sphincter resection (PESR). A series of 199 patients underwent curative ISR with or without PESR between 2000 and 2008, with 49 receiving preoperative chemoradiotherapy (CRT group) and 150 undergoing surgery first (surgery group). Overall survival (OS), disease-free survival (DFS), and local relapse-free survival (LFS) rates were calculated using Kaplan-Meier methods. Functional outcomes were assessed using the Wexner incontinence score. QOL was investigated using the Short-Form 36 questionnaire (SF-36) and modified fecal incontinence quality of life (mFIQL) scale. After a median follow-up of 78 months (range 12-164 months), estimated 7-year OS, DFS, and LFS rates were 78, 67, and 80 %, respectively. LFS was better in the CRT group than in the surgery group (p = 0.045). Patients with PESR or positive circumferential resection margins showed significantly worse survival. The median Wexner incontinence score at > 5 years was 8 in the surgery group and 10 in the CRT group (p = 0.01). QOL was improved in all physical and mental subscales of the SF-36 at > 5 years. Although the mFIQL showed a relatively good score in all groups at > 5 years, a significant difference existed between the CRT and surgery groups (p = 0.008). With long-term follow-up, oncologic, functional, and QOL results after ISR appear acceptable, although CRT is associated with disturbance.Annals of Surgical Oncology 06/2014; 21(11). DOI:10.1245/s10434-014-3762-y · 3.94 Impact Factor
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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.