Intersphincteric resection with excision of internal anal sphincter for conservative treatment of very low rectal cancer
Intersphincteric resection with excision of internal anal sphincter for conservative treatment of very low rectal cancer
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DOI：
10.1007/bf02238569
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发表时间：
1999-09-01
影响因子：
3.9
通讯作者：
Parneix, M
中科院分区：
文献类型：
--
作者：
Rullier, E;Zerbib, F;Parneix, M
目的：距离肛缘低于 5 厘米或距离肛环不到 1 厘米的低位直肠癌的标准手术治疗是腹会阴切除术。这是因为既需要获得足够的远端边缘又需要保留整个肛门括约肌。本研究的目的是评估括约肌间切除术、肛门内括约肌切除和低位结肠吻合术治疗肛门直肠交界癌的发病率、肿瘤学和功能结果。方法：从1990年1月至1996年12月，对16例患者进行前瞻性研究。所有患者均患有浸润性腺癌（5 个 T2 和 11 个 T3），位于距肛缘 2.5 至 4.5（平均 3.6）厘米之间。所有病例均进行直肠切除，远端最小切缘为 2（平均 2.4）cm； 6 名患者接受了内括约肌部分切除，10 名患者接受了次全切除。 8 例病例中，结肠 J 型袋与结肠肛门吻合有关。 12名患者接受了术前放疗，3名患者同时接受了化疗； 5例患者接受术后化疗。结果：无术后死亡。 4 名患者发病，其中两人在盆腔出血或阴道阴道瘘后接受了永久性结肠造口术。中位随访44个月（范围11-92）后，未观察到局部复发，两名患者死于远端转移。五年精算生存率为 75%。一半患者的节制能力正常，而其他偶尔出现轻微漏尿的患者则有所改变。次全切除后的中位静息压低于内括约肌部分切除后的中位静息压（40 vs. 70 cm H2O；P = 0.02），但两组的功能结果相似。结论：这些初步结果表明，对于位于肛门直肠交界处的选定直肠肿瘤，括约肌间切除术可以替代腹会阴切除术，且不影响治愈机会。肛门内括约肌次全切除并未改变功能结果和节制能力。
PURPOSE: Standard surgical treatment for low rectal cancer situated below 5 cm from the anal verge or at less than 1 cm from the anal ring is abdominoperineal resection. This is because of the necessity both to achieve a sufficient distal margin and to preserve the whole of the anal sphincter. The aim of this study was to evaluate morbidity, oncologic, and functional results of intersphincteric resection with excision of the internal anal sphincter and low coloanal anastomosis for carcinomas of the anorectal junction. METHODS: From January 1990 to December 1996, 16 patients were studied prospectively. All patients had an infiltrating adenocarcinoma (5 T2 and 11 T3), located between 2.5 and 4.5 (mean, 3.6) cm from the anal verge. Rectal resection with a minimum distal margin of 2 (mean, 2.4) cm was performed in all cases; six patients underwent partial resection of the internal sphincter, and ten patients had a subtotal resection. A colonic J-pouch was associated with coloanal anastomoses in eight cases. Twelve patients had preoperative radiotherapy, 3 with concomitant chemotherapy; 5 patients had postoperative chemotherapy. RESULTS: There was no postoperative mortality. Morbidity occurred in four patients, of whom two underwent permanent colostomy after pelvic hemorrhage or anovaginal fistula. After a median follow-up of 44 (range, 11-92) months, no local recurrence was observed, and two patients died of distal metastases. The five-year actuarial survival rate was 75 percent. Continence was normal in one-half of patients and was altered in the other patients who suffered from occasional minor leaks. The median resting pressure was lower after subtotal than after partial resection of the internal sphincter (40 vs. 70 cm H2O; P = 0.02), but functional results were similar in the two groups. CONCLUSION: These preliminary results suggest that intersphincteric resection can be an alternative to abdominoperineal resection for selected rectal tumors situated at the anorectal junction, without compromising chance of cure. Functional results and continence were not altered by subtotal resection of the internal anal sphincter.