Optimizing the selection of patients with low rectal cancer for intersphincteric resection by evaluating vertical invasion to the levator and external sphincter
Aim The indications for intersphincteric (ISR) anterior resection are not clearly defined. The aim of this study was to evaluate vertical extension of T2 or T3 low rectal cancer treated by rectal amputation to optimize patient selection for ISR. Method The abdominoperineal excision specimens of T2 o...
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Published in | Colorectal disease Vol. 17; no. 2; pp. 133 - 140 |
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Main Authors | , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
England
Blackwell Publishing Ltd
01.02.2015
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Subjects | |
Online Access | Get full text |
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Summary: | Aim
The indications for intersphincteric (ISR) anterior resection are not clearly defined. The aim of this study was to evaluate vertical extension of T2 or T3 low rectal cancer treated by rectal amputation to optimize patient selection for ISR.
Method
The abdominoperineal excision specimens of T2 or T3 low rectal cancer from 53 patients treated between 1992 and 2004 were retrospectively reviewed. Vertical invasion was quantified by measuring the shortest distance between the tumour and the striated muscle (T‐SM), assuming that this represented the surgical margin that would have be achieved had an ISR been performed.
Results
Involvement of the dentate line (DL) and intramural distal spread were independent risk factors for T‐SM ≤ 2 mm. The T‐SM was less when the inferior border of the tumour was on the distal side of the DL (r = 0.572, P < 0.001). The probability of involvement of the DL, intramural distal spread or either one of these being associated with T‐SM ≤ 2 mm was 43, 46 and 43%, respectively. All patients without both intramural distal spread and involvement of the DL had T‐SM > 2.
Conclusion
We recommend that ISR should only be performed for patients with T2 or T3 low rectal cancer in whom the lowest edge of the tumour is above the DL and there is no intramural distal spread. Such patients are relatively unlikely to have a T‐SM ≤ 2 mm. |
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Bibliography: | ArticleID:CODI12769 ark:/67375/WNG-MLXW2QK8-6 Grants-in-Aid for Scientific Research istex:10755FA8C753F1893F080BD39185540E0AFAF08D Japan Society for the Promotion of Science ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 1462-8910 1463-1318 |
DOI: | 10.1111/codi.12769 |