Intersphincteric resection for low rectal tumours

TLDR

The study involves 38 patients with low rectal tumours, including 34 cancers and 4 carcinoid or villous adenomas, treated since 1984. The authors aim to describe an abdominoperineal operation that extends rectal resection into the intersphincteric plane with removal of the internal sphincter. The procedure involves intersphincteric resection and coloanal anastomosis to restore bowel continuity. In this cohort, there was no mortality, a 10.5 % local recurrence rate over a median 3‑year follow‑up, satisfactory continence, and a significant persistent reduction in resting anal pressure.

Abstract

Abstract An abdominoperineal operation is described that extends rectal resection for low tumours into the intersphincteric plane with removal of the internal sphincter. Bowel continuity is restored by coloanal anastomosis. Of 38 patients who underwent surgery since 1984, 34 had low rectal cancer and four carcinoid or large villous adenoma. There was no mortality. Four patients developed local recurrence during a median observation period of 3 years. Continence was satisfactory in all patients. The median daily number of bowel movements during the first months after colostomy closure was 9 but decreased to 3 after 1 year and 1 after 2 years. Anal manometry demonstrated a significant reduction of mean resting pressure from 91·8 to 35·1 cmH2O with no recovery after 2 years (P<0·0001). Squeeze pressure showed only a transient decrease.