Abstract
Background: The intersphincteric resection the most extreme form of a
sphincter-preserving alternative for the abdominoperineal resection. Aim of
the Work: We investigated oncological, functional outcomes and morbidity
after ISR. Methods: This retrospective study included 164 patients who underwent
ISR with between 2010 and 2015, Male 56.1%, Female 43.9%, with a
median age was 54.5 years, Median follow-up time was of 48 months, Average
surgical time was 230 min, Median blood loss was 700 mL and median hospital
stay was nine days. Mean tumour size was 34 mm. The surgical procedure
through a laparotomy (72.6%), laparoscopically (27.4%). Neoadjuvant
radiotherapy 89.6% {long-course radiotherapy 74.4%, short-course radiotherapy
15.2%}, neoadjuvant chemotherapy 28.7% and adjuvant chemotherapy
70.1%. Colonic J-pouch 16.5%, Transverse coloplasty 15.9%, a side-to-end
anastomosis 26.8% and straight coloanal anastomosis 40.9%. Partial-ISR
36.6%, subtotal-ISR 37.2%, total-ISR 26.2%, diverting ileostomy 6.7%. Results:
Operative mortality 1.2%, morbidity 14.6% (anastomotic leakage 3.7%,
anastomotic stenosis 1.8%, a recto-vaginal fistula 2.4% bowel obstruction 3%,
surgical site infection 3%. Respiratory tract infection 1.2%, local 7.9%, distant
recurrence 15.2%, 5-year overall 79.8%, disease-free survival 75.8%, R0 resection
95.1%. Pathologic complete response 11%. Circumferential margin involvement
2.4%. Median number of lymph nodes 17. Mean distal margin 20
mm, after 12 months Median Wexner score 6. Incontinence for (flatus 11%,
liquid 4.9%, solid 4.3%). Median bowel motions in a 24-h were 3. Faecal urgency
17.7%. Stool fragmentation 18.9%. Difficult evacuation 17.7%, lifestyle alteration 14.6%. Difficulty Feces/flatus discrimination 43.3%. Nocturnal soiling
in 17.1%. Daytime soiling 11%. Pad wearing 23.8%. Anti-diarrhoea medication
loperamide 14%. Conclusion: ISR is a feasible surgical procedure for low rectal
cancer. Oncologic and functional, outcomes after are acceptable.