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Abstract
Aim: To evaluate the: oncologic safety and functional outcomes of intersphincteric resection (ISR) and to study the effect of neoadjuvant concomitant chemoradiotherapy (CCRT) on downstaging of primary tumor, hence sphincter preservation rate and outcome. Patients & methods: patients presenting to the National Cancer Institute-Cairo University from May 2014 to October 2014 ; with locally advanced low (3-6m from the anal verge ) rectal cancer received long-course CCRT and the response was evaluated, then they were subjected to ISR, APR or LAR accordingly. Those patients who underwent ISR were followed for the short-term outcomes of ISR. Results: the study started by 60 patients; 33/60 (55%) underwent APR, 21/60 (35%) underwent ISR, 4/60 (6.7%) underwent LAR and 2/60 patients (3.3%) lost follow up. The clinical response was assessed by the status of the distance from the anal verge: it increased in 23/60 patients (38.33%), stationary in 17/60 patients (28.33%) and decreased in 20/60 patients. The radiological response showed: downstaging occurred in 27/60(45%). Pathological response revealed: Downstaging in 28/58 patients (48.3%). Regarding the ISR technique: There was no mortality. Ten patients had postoperative complications. All cases had free distal margin and one patient had +ve radial margin. The Improvement of all functional aspects occurred with time. Kirwan’s grade of continence by the 15th month was: I: 5/16(31.3%), II: 8(50%) and III: 3(18.8%). This is very clear comparing it with 3rd month results: II: 3/19(15.8%), III: 13(68.4%) and IV: 3(15.8%). Correlation analysis between functional outcomes and different factors ( pouch, stoma, ISR type , age and sex) revealed: pouch formation and type of ISR had significant correlations with some functional aspects. Conclusion: Intersphincteric resection is an oncologically safe alternative to the standard APR in low rectal cancer, with the added benefit of avoiding a permenant stoma. The use of preoperative concomitant chemoradiotherapy (CCRT) enhances the rate of ISR by downsizing and downstaging of the tumors