| Objective: To evaluate the radical curative effects and postoperativeanal function of transanal intersphincteric resection (ISR) combinedwith total mesorectal excision (TME) for patients with T1and T2ultra-low rectal cancer.Methods: We made a retrospective study of the clinical data of34patients undergoing ultra low rectal cancer from January2008toJanuary2012in our hospital, who were treated with transanalintersphincteric resection (ISR), combined with total mesorectalexcision (TME). The total mesorectal excision (TME) was performed byabdominal surgery group, while the perineal surgery group operatedadhering to the principle of transanal intersphincteric resection(ISR). The surgeon of perineal group dissected rectal mucous membraneand all layer of anal inner sphincter2-4cm below the lower edge ofthe tumor, vertically to the longitude axis of the anal canal. Thenthe rectum and sphincter were freed up to the upper flange of theexternal sphincter ring from internal and external sphincterclearance, ascending to the abdominal surgery group. The internalsphincter was removed totally or partially (some cases keep thecontralateral dentate line of the malignancy). The colon and the distal anal canal were performed an end to end anastomosis. All caseswere analyzed with the data of preoperative tumor staging, distalresection margin frozen pathology, postoperative complications andthe function of the anus.Results:34patients (21males and13females) with an age ranged36-69years old in our study. Among them, total ISR was performed in11cases,partial ISR in13cases and ISR keeping partial dentate line in10cases. According to the UICC TNM classification,16cases had a T1stage tumor (N0in9cases and N1in7cases), and18patients a T2stage (N0in12case and N1in6cases). The histologic and pathologicfindings of differentiation were proven as well-differentiatedadenocarcinoma in11cases, moderately differentiated in16cases andpoorly differentiated in7cases. The average diameter of themalignancy and the distance between the tumor and the dentate linewere3.74±0.32cm, and1.77±0.26cm, respectively.Intraoperative time was156.65±14.20min, and blood loss was121.47±33.79ml, the length of bowel removed is on average of22.04+0.53cm, the average distance of distal resection margin was2.12±0.21(1.8~2.5)cm, the average number of lymph nodes cleaned is14.41±2.44(12~20),and all distal resection margin frozen pathologicalexamination were negative for malignancy. There were no significantdifferences between the three groups in terms of the above. All caseswere followed up for12~45(22.94±6.29)months; a total of10casesof postoperative complications were occurred, including anastomotic leakage in1case, anastomotic stenosis in1case, local recurrencein2cases, incision infection in3cases and3cases of perianal eczema.There was none death during follow-up. The two of local recurrencewere in survival since APR and other complications were cured withconservative treatment. According to the defecate standard ofWilliams’s,67.64%(23/34),67.64%(27/34) and93.9%(31/33) ofpatients reached good effect function in postoperative3,6,12months,respectively. In3,6months, the anal function of whom undergoingpartial ISR and ISR keeping partial dentate line was better than thatof total ISR (P=0.025and P=0.046, P=0.023and P=037,respectivelyin3and6months),Conclusion: The results of our study show that intersphinctericresection with total or partial removal of the internal sphinctercombined with TME may be a viable therapy in selected T1-T2ultra-lowrectal cancer for the optimal oncological and functional outcomes.To keep the dentate line and part of the internal sphincter as faras possible may be conductive to the postoperative anal defecationcontrol function. |
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