Intersphincteric resection for low-lying rectal cancer: analysis of risk factors and establishment of a preoperative assessment system for postoperative anal function.
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Abstract
Purpose: In recent years, intersphincteric resection has increasingly become a viable alternative to abdominoperineal resection due to its significant preservation of the anus. Previous studies have indicated that intersphincteric resection has provides comparable oncological outcomes to APR, but anal incontinence remains a common postoperative complication. we reassessed identify preoperatively controllable and measurable risk factors that may affect anal function following intersphincteric resection, and to attempt to construct a preoperative risk assessment system for anal function after intersphincteric resection, thereby standardizing intersphincteric resection treatment for low rectal cancer.
Materials and methods: This single-center retrospective study included 51 patients who underwent intersphincteric resection surgery between January 2018 and March 2023 and maintained autonomous defecation for one year or more were selected. Using Independent samples t-test, rank-sum test, Fisher's exact test, and linear regression, we analyzed anal function at 12 months postoperatively and the clinical factors influencing it. Construction of a postoperative fecal incontinence risk assessment scale for ISR based on standardized coefficients in multifactorial linear regression.
Results: Age, clinical T stage, preoperative puborectalis muscle thickness, and preoperative chemoradiotherapy were identified as independent factors affecting postoperative anal function.
Conclusions: Older age, higher clinical T stage, thinner preoperative puborectalis muscle thickness, and preoperative chemoradiotherapy are associated with poorer postoperative anal function. Patients with 0-1 high-risk factors can be recommended for intersphincteric resection treatment; those with 3 high-risk factors should not undergo intersphincteric resection; and patients with 2 high-risk factors should have a thorough discussion regarding the potential risks before a cautious surgical decision is made.
期刊介绍：
Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.
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