OBJECTIVE: The most extended form of rectal resection, representing the very last option for sphincter preservation is abdomino-peranal intersphincteric resection for tumours of the lower third which otherwise would not be resectable with preservation of the sphincter by an abdominal approach alone. PATIENTS AND METHODS: The data of 476 patients with a carcinoma in the lower third of the rectum who underwent primary treatment for stage I-III disease by low anterior resection, abdomino-peranal (intersphincteric) resection or abdominoperineal excision between 1985 and 2001 were analysed. The time periods 1985-94 and 1995-2001 were compared. RESULTS: The rate of intersphincteric resections increased from 3% in 1985-94 to 27% in 1995-2001 while abdominoperineal excisions decreased. Postoperative complication rate was not increased in intersphincteric resections (25%) while postoperative mortality did not differ between the operative procedures. The overall 5-year-rate of locoregional recurrence decreased from 18% to 16%. In intersphincteric resections 14.2% of the patients treated with radiochemotherapy developed locoregional recurrence, while this rate was 46.5% (7/18) if adjuvant treatment was not administered (P = 0.0200). The cancer-related 5-year survival rate was not altered by intersphincteric resection. CONCLUSION: In carcinomas of the lower third of the rectum, the application of abdomino-peranal intersphincteric resection can reduce the need for rectal excision by 20%. Neo-/adjuvant radiochemotherapy is required to reduce locoregional recurrence to an acceptable level.
OBJECTIVE: The most extended form of rectal resection, representing the very last option for sphincter preservation is abdomino-peranal intersphincteric resection for tumours of the lower third which otherwise would not be resectable with preservation of the sphincter by an abdominal approach alone. PATIENTS AND METHODS: The data of 476 patients with a carcinoma in the lower third of the rectum who underwent primary treatment for stage I-III disease by low anterior resection, abdomino-peranal (intersphincteric) resection or abdominoperineal excision between 1985 and 2001 were analysed. The time periods 1985-94 and 1995-2001 were compared. RESULTS: The rate of intersphincteric resections increased from 3% in 1985-94 to 27% in 1995-2001 while abdominoperineal excisions decreased. Postoperative complication rate was not increased in intersphincteric resections (25%) while postoperative mortality did not differ between the operative procedures. The overall 5-year-rate of locoregional recurrence decreased from 18% to 16%. In intersphincteric resections 14.2% of the patients treated with radiochemotherapy developed locoregional recurrence, while this rate was 46.5% (7/18) if adjuvant treatment was not administered (P = 0.0200). The cancer-related 5-year survival rate was not altered by intersphincteric resection. CONCLUSION: In carcinomas of the lower third of the rectum, the application of abdomino-peranal intersphincteric resection can reduce the need for rectal excision by 20%. Neo-/adjuvant radiochemotherapy is required to reduce locoregional recurrence to an acceptable level.
Authors: Susanne Merkel; Klaus Weber; Maximilian Brunner; Justus Baecker; Abbas Agaimy; Jonas Göhl; Werner Hohenberger; Vera Schellerer; Robert Grützmann Journal: Int J Colorectal Dis Date: 2018-12-04 Impact factor: 2.571
Authors: Angela Fischer; Ignazio Tarantino; René Warschkow; Jochen Lange; Andreas Zerz; Franc H Hetzer Journal: Int J Colorectal Dis Date: 2010-02-03 Impact factor: 2.571
Authors: R E Horch; W Hohenberger; A Eweida; U Kneser; K Weber; A Arkudas; S Merkel; J Göhl; J P Beier Journal: Int J Colorectal Dis Date: 2014-04-22 Impact factor: 2.571
Authors: Johannes Klose; Ignazio Tarantino; Yakup Kulu; Thomas Bruckner; Stefan Trefz; Thomas Schmidt; Martin Schneider; Thilo Hackert; Markus W Büchler; Alexis Ulrich Journal: J Gastrointest Surg Date: 2016-12-15 Impact factor: 3.452