Annals of Coloproctology

Case Report

Colorectal cancer

Treatment of side limb full-thickness prolapse of the side-to-end coloanal anastomosis following intersphincteric resection: a case report and review of literature: Guglielmo Niccolò Piozzi, Krunal Khobragade, Seon Hui Shin, Jeong Min Choo, Seon Hahn Kim; Ann Coloproctol. 2024;40(Suppl 1):S38-S43. Published online February 8, 2023; DOI: https://doi.org/10.3393/ac.2022.00829.0118

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Intersphincteric resection (ISR) with coloanal anastomosis is an oncologically safe anus-preserving technique for very low-lying rectal cancers. Most studies focused on oncological and functional outcomes of ISR with very few evaluating long-term postoperative anorectal complications. Full-thickness prolapse of the neorectum is a relatively rare complication. This report presents the case of a 70-year-old woman presenting with full-thickness prolapse of the side limb of the side-to-end coloanal anastomosis occurring 2 weeks after the stoma closure and 2 months after a robotic partial ISR performed with the Da Vinci single-port platform. The anastomosis was revised through resection of the side limb and conversion of the side-to-end anastomosis into an end-to-end handsewn anastomosis with interrupted stitches. This study describes the first case of full-thickness prolapse of the side limb of the side-to-end handsewn coloanal anastomosis following ISR. Moreover, a revision of all reported cases of post-ISR full-thickness and mucosal prolapse was performed.

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International standardization and optimization group for intersphincteric resection (ISOG‐ISR): modified Delphi consensus on anatomy, definition, indication, surgical technique, specimen description and functional outcome
Guglielmo Niccolò Piozzi, Krunal Khobragade, Vusal Aliyev, Oktar Asoglu, Paolo Pietro Bianchi, Vlad‐Olimpiu Butiurca, William Tzu‐Liang Chen, Ju Yong Cheong, Gyu‐Seog Choi, Andrea Coratti, Quentin Denost, Yosuke Fukunaga, Emre Gorgun, Francesco Guerra, Ma
Colorectal Disease.2023; 25(9): 1896. CrossRef

Review

Malignant disease, Rectal cancer ,Functional outcomes,Colorectal cancer,Minimally invasive surgery

Robotic Intersphincteric Resection for Low Rectal Cancer: Technical Controversies and a Systematic Review on the Perioperative, Oncological, and Functional Outcomes: Guglielmo Niccolò Piozzi, Seon Hahn Kim; Ann Coloproctol. 2021;37(6):351-367. Published online November 17, 2021; DOI: https://doi.org/10.3393/ac.2021.00836.0119

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42 Web of Science
42 Citations

Abstract PDF

Intersphincteric resection (ISR) is the ultimate anus-sparing technique for low rectal cancer and is considered an oncologically safe alternative to abdominoperineal resection. The application of the robotic approach to ISR (RISR) has been described by few specialized surgical teams with several differences regarding approach and technique. This review aims to discuss the technical aspects of RISR by evaluating point by point each surgical controversy. Moreover, a systematic review was performed to report the perioperative, oncological, and functional outcomes of RISR. Postoperative morbidities after RISR are acceptable. RISR allows adequate surgical margins and adequate oncological outcomes. RISR may result in severe bowel and genitourinary dysfunction affecting the quality of life in a portion of patients.

Citations

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European Journal of Surgical Oncology.2024; 50(6): 108308. CrossRef
Treatment of side limb full-thickness prolapse of the side-to-end coloanal anastomosis following intersphincteric resection: a case report and review of literature
Guglielmo Niccolò Piozzi, Krunal Khobragade, Seon Hui Shin, Jeong Min Choo, Seon Hahn Kim
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Case Report

Malignant disease, Rectal cancer,Colorectal cancer,Complication

Neorectal Mucosal Prolapse After Intersphincteric Resection for Low-Lying Rectal Cancer: A Case Report: Mohammed Alessa, Hyeon Woo Bae, Homoud Alawfi, Ahmad Sakr, Fozan Sauri, Nam Kyu Kim; Ann Coloproctol. 2021;37(Suppl 1):S15-S17. Published online April 22, 2021; DOI: https://doi.org/10.3393/ac.2020.02.22

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6 Web of Science
7 Citations

Abstract PDF

Radical resection for low rectal cancer is the mainstay among the treatment modalities. Intersphincteric resection (ISR) is considered a relatively new but effective surgical treatment for low-lying rectal tumor. As the sphincter preserving techniques get popularized, we notice uncommon complication associated with it in the form of rectal mucosal prolapse. We presented 2 rare cases that developed neorectal mucosa prolapse after ISR a complication following low rectal cancer surgery. Although ISR is a safe and effective surgical technique for low rectal cancer, it should be considered to correct modifiable possible risk factors. Also, Delorme procedure is good option for management of neorectal mucosal prolapse.

Citations

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Tailoring rectal cancer surgery: Surgical approaches and anatomical insights during deep pelvic dissection for optimal outcomes in low‐lying rectal cancer
Youn Young Park, Nam Kyu Kim
Annals of Gastroenterological Surgery.2024; 8(5): 761. CrossRef
Treatment of side limb full-thickness prolapse of the side-to-end coloanal anastomosis following intersphincteric resection: a case report and review of literature
Guglielmo Niccolò Piozzi, Krunal Khobragade, Seon Hui Shin, Jeong Min Choo, Seon Hahn Kim
Annals of Coloproctology.2024; 40(Suppl 1): S38. CrossRef
Surgical Treatment for Mucosal Prolapse after Intersphincteric Resection
Rina Takahashi, Makoto Takahashi, Yuki Ii, Megumi Kawaguchi, Hirotaka Momose, Shunsuke Motegi, Ryoichi Tsukamoto, Yu Okazawa, Masaya Kawai, Kiichi Sugimoto, Yutaka Kojima, Kazuhiro Sakamoto
Nippon Daicho Komonbyo Gakkai Zasshi.2023; 76(3): 299. CrossRef
Unveiling the profound advantages of total neoadjuvant therapy in rectal cancer: a trailblazing exploration
Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim, Donghyoun Lee, Chinock Cheong
Annals of Surgical Treatment and Research.2023; 105(6): 341. CrossRef
Clinical outcome of the Gant-Miwa-Thiersch procedure for colonic mucosal prolapse after intersphincteric resection—a single-center report from Japan
Toshikatsu Nitta, Masatsugu Ishii, Jun Kataoka, Sedakatsu Senpuku, Yasuhiko Ueda, Ryo Iida, Ayumi Matsutani, Takashi Ishibashi
Annals of Medicine and Surgery.2021; 72: 103005. CrossRef
Robotic Intersphincteric Resection for Low Rectal Cancer: Technical Controversies and a Systematic Review on the Perioperative, Oncological, and Functional Outcomes
Guglielmo Niccolò Piozzi, Seon Hahn Kim
Annals of Coloproctology.2021; 37(6): 351. CrossRef
Surgical Treatment of Low-Lying Rectal Cancer: Updates
Cristopher Varela, Nam Kyu Kim
Annals of Coloproctology.2021; 37(6): 395. CrossRef

Review

Intersphincteric Resection for Patients With Low-Lying Rectal Cancer: Oncological and Functional Outcomes: In Ja Park, Jin Cheon Kim; Ann Coloproctol. 2018;34(4):167-174. Published online August 31, 2018; DOI: https://doi.org/10.3393/ac.2018.08.02

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331 Download
25 Web of Science
22 Citations

Abstract PDF

The aim of this review is to evaluate the outcomes after an intersphincteric resection (ISR) for patients with low-lying rectal cancer. Reports published in the literature regarding surgical, oncological, and functional outcomes of an ISR were reviewed. The morbidity after an ISR was 7.7%–32%, and anastomotic leakage was the most common adverse event. Local recurrence rates ranged from 0% to 12%, 5-year overall survival rates ranged from 62% to 92%, and rates of major incontinence ranged from 0% to 25.8% after an ISR. An ISR is a safe procedure for sphincter-saving rectal surgery in patients with very low rectal cancer; it does not compromise the oncological outcomes of the resection and is a valuable alternative to an abdominoperineal resection. While the functional outcomes after an ISR were found to be acceptable, the long-term functional outcome and quality of life still require careful investigation. ISRs have been performed with surgical and oncologic safety on patients with low-lying rectal cancer. However, patients must be selected very carefully for an ISR, considering the associated functional derangement and the limited extent of the resection.

Citations

Citations to this article as recorded by

Long-term functional and prognostic outcomes of robotic intersphincteric resection for treating low rectal cancer: a single-center retrospective study
Yang Bo, Wang Yigao, Zheng Mingye, Jian Zhao, Yongxiang Li
International Journal of Colorectal Disease.2025;[Epub] CrossRef
Oncologic outcomes of intersphincteric resection versus abdominoperineal resection for lower rectal cancer: a systematic review and meta-analysis
Qiang Du, Wenming Yang, Jianhao Zhang, Siyuan Qiu, Xueting Liu, Yong Wang, Lie Yang, Zongguang Zhou
International Journal of Surgery.2024; 110(4): 2338. CrossRef
Does anastomotic leakage after intersphincteric resection for ultralow rectal cancer influence long-term outcomes? A retrospective observational study
Feifan Liu, Bin Zhang, Jianbin Xiang, Guangzuan Zhuo, Yujuan Zhao, Yiming Zhou, Jianhua Ding
Langenbeck's Archives of Surgery.2023;[Epub] CrossRef
Comparative study of functional outcomes between ultra‐low anterior resection and inter‐sphincteric resection: a propensity matched analysis
Jayesh Gori, Mufaddal Kazi, Barath Rajkumar, Prajesh Bhuta, Suman Kumar Ankathi, Ashwin Desouza, Avanish Saklani
ANZ Journal of Surgery.2022; 92(1-2): 151. CrossRef
Current status and role of robotic approach in patients with low-lying rectal cancer
Hyo Seon Ryu, Jin Kim
Annals of Surgical Treatment and Research.2022; 103(1): 1. CrossRef
Trans-Anastomotic Drainage Tube Placement After Hand-Sewn Anastomosis in Patients Undergoing Intersphincteric Resection for Low Rectal Cancer: An Alternative Drainage Method
Xinjian Zhong, Xiaoyu Xie, Hang Hu, Yi Li, Shunhua Tian, Qun Qian, Congqing Jiang, Xianghai Ren
Frontiers in Oncology.2022;[Epub] CrossRef
Functional outcomes of intersphincteric resection in low rectal tumors
Osman Bozbıyık, Cemil Çalışkan, Özgün Köse, Ozan Verendağ, Berk Göktepe, Tayfun Yoldaş, Erhan Akgün, Mustafa Ali Korkut
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Diwakar Pandey, Vivek Sukumar, Avanish Saklani
JAMA Surgery.2021; 156(2): 202. CrossRef
Local recurrence with intersphincteric resection in adverse histology rectal cancers. A retrospective study with competing risk analysis
Ashwin L. Desouza, Mufaddal Kazi, Kamlesh Verma, Pavan Sugoor, Balu K. Mahendra, Avanish P. Saklani
ANZ Journal of Surgery.2021; 91(11): 2475. CrossRef
A case of effective Delorme’s procedure for colonic mucosal prolapse after intersphincteric resection
Akihiro Kohata, Wataru Shimizu, Masatoshi Kochi, Yuji Takakura, Hideki Ohdan
Journal of Surgical Case Reports.2021;[Epub] CrossRef
Oncologic and Functional Outcomes of Pelvic Perineal Reconstruction by Perineal Colostomy and Malone Procedure After Abdominoperineal Resection
Anthony Marinho, Nicolas Zalay, Léonor Chaltiel, Sylvain Kirzin, Antoine Philis, Jannick Selves, Nicolas Carrère, Etienne Buscail, Laurent Ghouti
Diseases of the Colon & Rectum.2021; 64(12): 1501. CrossRef
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Eun Jung Park, Seung Hyuk Baik
Precision and Future Medicine.2021; 5(4): 164. CrossRef
Robotic Intersphincteric Resection for Low Rectal Cancer: Technical Controversies and a Systematic Review on the Perioperative, Oncological, and Functional Outcomes
Guglielmo Niccolò Piozzi, Seon Hahn Kim
Annals of Coloproctology.2021; 37(6): 351. CrossRef
Surgical Treatment of Low-Lying Rectal Cancer: Updates
Cristopher Varela, Nam Kyu Kim
Annals of Coloproctology.2021; 37(6): 395. CrossRef
Oncologic safety and bowel function after ultralow anterior resection with or without intersphincteric resection for low lying rectal cancer: Comparative cross sectional study
Ahmad Sakr, Seung Yoon Yang, Jae Hyun Kang, Min Soo Cho, Yoon Dae Han, Byung Soh Min, Waleed Thabet, Hosam Ghazy Elbanna, Mosaad Morshed, Nam Kyu Kim
Journal of Surgical Oncology.2020; 121(2): 365. CrossRef
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Latest Advances in Intersphincteric Resection for Low Rectal Cancer
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Original Articles

Intersphincteric Resection versus Stapled Coloanal Anastomosis for Low Rectal Cancer.: Lee, Bong Hwa , Kim, Jong Wan , Chang, Mi Young , Park, Hyoung Chul , Lee, Hae Wan; J Korean Soc Coloproctol. 2008;24(2):113-120.; DOI: https://doi.org/10.3393/jksc.2008.24.2.113

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19 Download

Abstract PDF: PURPOSE
Local control and functional results of an intersphincteric resection are controversial in Asian, low BMI patients, even though it might a provide a chance to avoid a permanent colostomy. We tried to evaluate the potential risk of an intersphincteric resection, compared with a stapled coloanal anastomosis, in patients with low rectal cancer. METHODS: Patients with low rectal cancer, who underwent a intersphincteric resection with a hand-sewn anastomosis (ISR) or a coloanal anstomosis with staples (stapled CAA), were analyzed. RESULTS: From 1999 to 2006, 85 patients were enrolled. The distance between the anal verge and the lower margin of the tumor was 3.4+/-0.8 cm (range: 2~5 cm) in the ISR group and 4.9+/-0.8 cm (range: 3~7 cm) in the stapled CAA. The mean body mass index was 23 (range: 18~32). The patients complained postoperatively of intolerable anal incontinence (Kirwan's class > 2) in 35% of the ISR group and in 9% as the stapled CAA group, (P<0.02). The local recurrence rate was greater in the ISR group (15%) than in the stapled CAA group (2%, P<0.04). There was no significant difference in distant metastasis between the two groups. The disease-free survival rates were 80.8% and 91.2% at three years in the ISR group and the stapled CAA group, respectively. Complications, such as urinary incontinence and sexual dysfunction in male patients, were not significantly different between the two groups. CONCLUSIONS: An intersphincteric resection with hand-sewn anastomosis could be worse than a stapled coloanal anastomosis in function and local recurrence. This may indicate that careful selection is required for a intersphincteric resection even when a stapled anastomosis cannot be applied due to a narrow margin.

Intersphincteric Resection for Very Low Rectal Cancer.: Kim, Jae hun , Oh, Nahm gun; J Korean Soc Coloproctol. 2004;20(6):364-370.

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8 Download

Abstract PDF: PURPOSE
In the treatment of rectal cancer, sphincter saving resection is increased but low anterior resection is limited in treatment for low rectal cancer below 4 cm from the anal verge. In other reports intersphincteric resection can allow an oncologically safe resection margin and has good functional results in very low rectal cancer. The aim of this study is to evaluate the morbidity, mortality and the oncological and functional results of intersphincteric resection.
METHODS
Between 2000 and 2002, 18 patients (mean age 54 years, range 35~70) with adenocarcinoma of the rectum underwent intersphincteric resection by an transanal approach with a colonic J-pouch anal anastomosis and ileostomy. The mean distance between the tumor and anal verge was 3.75 (range 2.5~5) cm. Patients with T3 lesion were 8 and they were received preoperative radiochemotherapy. Others with T2 lesion were not received preoperative radiochemotherapy.
RESULTS
There was no postoperative mortality and local recurrance after median follow up of 32 (18~54) months. Morbidity occurred in 9 patient but were not serious. Two anastomotic leakages occurred. One was recovered after only conservative therapy, but the other one was received colostomy because of functional problem. Downstaging was observed in 62.5% (5/8) of the patients. Continence was good (Kirwan classification I, II) in 72% (13/18) of patients.
CONCLUSIONS
These results suggest that intersphincteric resection can be an alternative procedure to abdominoperineal resection for very low rectal cancer without losing chance of cure.

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