Short Term Outcomes of Intersphincteric Resection with Total Mesorectal Excision for Low Rectal Carcinoma

Background: The study assessed the short term surgical, oncological and functional outcomes of intersphincteric resection.Methods: During the period between December 2012 and October 2015 (a total of 35 months), 70 patients presented with low rectal carcinoma were operated by ISR with TME in a joint supervision study between Oncology Center of Mansoura University, Egypt and Sapienza University, Rome, Italy.Results: Intraoperative morbidity occurred in 5 cases; a hemorrhage from the presacral plexus, posterior wall vaginal tear which repaired from intra-vaginal suturing and a splenic capsule tear treated conservatively, ureteric injury and respiratory distress. The median ISR operative time was 240±97.3. The time needed for narcotic analgesia was 54±18.7 hours. The complications occurred in 28.6% of patients are as following; Colonic necrosis in 4 patients (5.7%), anastomotic fistulas in. 6 cases (8.5%), pelvic abscess in 5 cases (7.1%), Pelvic hematoma in 1 case (1.4%), prolonged ileus in 1 case (1.4%), wound infection in 4 cases (5.7%), and non-surgical complications in the form of pneumonia and pulmonary edema in 2 cases. One mortality after 25 days due to pulmonary and cardiogenic edema in the open group. The late postoperative complications occurred in 5 cases (7.1%) which include; 4 anal stenosis (5.7%) and 1 Anovaginal fistula due to recurrent adenocarcinoma. The overall recurrence after ISR was 7 cases (10%) after a mean follow period of 24 months. Local recurrence occurred in 3 cases (4.3%) while distant recurrence occurred in 4 cases (5.7%). Two years disease-free survival was 89.9%. Two years survival was 97% after ISR for low rectal cancer. Clinical assessment using Kirwan grading score after 9 months showed that 60 patients (87.6%) had good functional outcome (grade I/II).Conclusion: ISR with TME help avoiding permanent stoma and provides a reasonable short term surgical, functional and oncological outcomes.