The Role of Intersphincteric Resection in Very Low Rectal Cancer

Excerpt

In a recent issue of the Annals of Surgical Oncology, You et al. reported twice on rectal cancer providing valuable information.1,2 They noted that cancer of the rectum in younger patients (younger than age 50) has increased in frequency and appears to be more aggressive, because it is more advanced at the time of diagnosis and has greater likelihood of recurrence.1 Local recurrence not only reduces the life expectancy but also affects the quality of life by causing persistent pain, bleeding, intestinal obstruction, fistulas, and chronic pelvic sepsis. This possibility should be assessed properly; thus, it remains a challenge for the surgeon, although its occurrence has been significantly reduced.2 There is no doubt that abdominoperineal resection ensures radicality from the oncological point of view, and this is the reason why it was the method of choice for cancer of the lower third of the rectum. However, the cost is too heavy, given that it limits the patient’s quality of life and his/her sexual activity. The achieved progress in current technology, chemotherapy, and radiotherapy, combined with a better understanding of the microscopic peripheral invasion of the tumor (the limit should not exceed 10–15 mm), have led to the planning and application of alternative policies of surgical treatment. The preservation of the anus and the avoidance of permanent colostomy increase the options of rectal surgery and ensure effective restoration and anatomical integrity. The use of stapler devices expanded the limits of low anterior resection and, combined with total mesorectal excision (TME), consist of a current effective treatment for cancer of the distal rectum with low rates of local recurrence.3 ^– 5 Modern laparoscopic and robotic surgery comprise less invasive surgery and offer greater accuracy.6,7 …