Asian Journal of Research in Surgery

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Comparative Study between Classic Abdominoperineal Resection versus Sphincter Saving Techniques for Treatment of Low Rectal Cancer

  • Mohamed Salah Abdelhamid
  • Hisham Ahmed Nafady
  • Amro Ali Bacheet
  • Mohamed Hassan Korani
  • Ahmed Zaky Garib
  • Mahmoud Ahmed Negida

Asian Journal of Research in Surgery, Page 1-5

Published: 24 May 2019

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Abstract


Introduction:  Intersphincteric resection of low rectal tumors.is a surgical technique extending rectal resection into the intersphincteric space. This procedure is performed by a synchronous abdominoperineal approach with mesorectal. excision and excision of the entire or part of the internal sphincter.


Aim of the Work: is to evaluate the oncological and functional outcome of classic abdominoperineal resection (APR) compared to sphincter sparing ( intersphincteric  resection) (ISR) procedures.


Patient: Group A patients (10 patients): who meet the criteria of ISR possibility and candidates for sphincter preserving procedures Group B patients (10 patients): Who didn’t meet the criteria to do ISR, were subjected to APR. The number of the patients in this short research article were small as it is a preliminary study.


Methods: Total ISR involves complete excision of the internal sphincter. The cut line is at the intersphincteric groove. B. Subtotal ISR involves partial excision of the internal sphincter. The cut line is between the dentate line and the intersphincteric groove. C. Modified partial ISR the cut line is below the dentate line on one side of the tumor. On the opposite side of the tumor, the cut line is above the dentate line. D Partial ISR the cut line is at or above the level of the dentate line.


Results: showed that after 6 months, out of 10 patients underwent ISR, 6 patients were highly satisfied with Grade I continence according to Kirwan’s grade. While 4 patients were Grade II, i.e.: Incontinent to flatus. Non significant difference in the rate of recurrence between the two groups.


Conclusion:  In low rectal cancer, the sphincter preservation appears to have nearly the same oncologic outcome compared to APR,. However, patients with sphincter preservation have certainly demonstrated an indisputable better functional outcome, in terms of stoma avoidance and adequate continence.


Keywords:
  • Cancer
  • rectum-abdominoperineal
  • resection-sphincter saving
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How to Cite

Abdelhamid, M., Nafady, H., Bacheet, A., Korani, M., Garib, A., & Negida, M. (2019). Comparative Study between Classic Abdominoperineal Resection versus Sphincter Saving Techniques for Treatment of Low Rectal Cancer. Asian Journal of Research in Surgery, 2(1), 1-5. Retrieved from https://journalajrs.com/index.php/AJRS/article/view/30091
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References

Taylor FGM, et al. Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: A prospective, multicenter, European study. Annals of Surgery. 2011; 253(4):711–719 .

Schiessel R, et al. Technique and long-term results of intersphincteric resection for low rectal cancer. Diseases of the Colon and Rectum. 2005;48(10):1858–1865.

Sanghera P, et al. Chemoradiotherapy for rectal cancer: An updated analysis of factors affecting pathological response. Clinical oncology (Royal College of Radiologists (Great Britain)). 2008;20(2): 176–83 .

Rullier E, Goffre B, et al. Preoperative radiochemotherapy and sphincter-saving resection for T3 carcinomas of the lower third of the rectum. Annals of Surgery. 2001;234(5):633–40.

Roscurshim IG, Angelita Habr Gama, Rodrigo Oliva P. Interval between surgery and neoadjuvant chemoradiation therapy for distal rectal cancer: Does delayed surgery have an impact on outcome? International Journal of Radiation Oncology, Biology, Physics. 2008;71(4): 1181–1188.

Kirwan RP, Lian L, Lavery IC. Does a subcentimeter distal resection margin adversely influence oncologic outcomes in patients with rectal cancer undergoing restorative proctectomy? Diseases of the Colon and Rectum. 2011;54(2):157–163.

Gawad I, Fakhr M, Lotayef O, Mansour N, Mokhtar. Journal of the Egyptian National Cancer Institute. 2015;27:19-24 .

Bujko K, et al. Is the 1-cm Rule of Distal Bowel Resection Margin in Rectal Cancer Based on Clinical Evidence? A Systematic Review. Annals of Surgical Oncology. 2012;19(3):801–808.

Bujko K, et al. Long-term results of a randomized trial comparing preoperative short- course radiotherapy with preo-perative conventionally fractionated chemoradiation for rectal cancer. British Journal of Surgery. 2006;93(10):1215–1223.
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