Review of Intersphincteric Resections for Rectal Cancer Treatment

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Author Info

Seke Manase Ephraim KAZUMA Rigved Nittala Vivek Sukumar Mufaddal Kazi Avanish Saklani

Corresponding Author

Avanish Saklani
Professor and Consultant Colorectal Surgeon and Head of Department of Colorectal Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai, India

A B S T R A C T

Colorectal cancer is the third most common cancer, second most common cancer in women, and the fourth leading cause of death in the world. Radical surgical treatment with Total Mesorectal Excision (TME) is considered the best treatment for cancer found in the lower third of the rectum and has benefits of complete tumor removal to reduce risk of recurrence and to improve survival. Advances in preoperative chemoradiation therapy have increased chances of achieving a 1 cm distal margin and allowed successful sphincter-preserving surgery by intersphincteric resection (ISR) and Coloanal Anastomosis (CAA) that allows normal defecation. MRI is particularly useful in evaluating localization of the tumor, involvement of anal sphincter (internal and external sphincters), levator ani muscles, and adjacent structures to the anus, with an accuracy of 85%, sensitivity of 87%, and specificity of 75%. Performing ISR with TME oncologic principles achieves similar results to Low Anterior Resection (LAR), but depends on the presence of sufficient Distal Rectal Margin (DRM); if a sufficient DRM cannot be achieved, then patients are offered an Abdominoperineal Resection (APR) with permanent colostomy and poor quality-of-life results.

Article Info

Article Type

Review of the Literature

Publication history

Received: Fri 05, Mar 2021
Accepted: Tue 16, Mar 2021
Published: Sat 03, Apr 2021

Copyright

© 2023 Avanish Saklani. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.
DOI: 10.31487/j.SCR.2021.04.03