**3. Results**

The medium hospital stay was 9 days. Bowel movement resumed on the first or second day following surgery.

disease. The median Wexner score was **8.2** in the case of these patients, and they declared that they are satisfied regarding the choice of surgery and the level of continence, under the terms

Quality of Life Following Intersphincteric Resections for Low Rectal Cancer: Early Results

http://dx.doi.org/10.5772/intechopen.79727

119

Although intersphincteric resections are relatively "new to the surgeon's arsenal" numerous studies have been published regarding its effectiveness and overall satisfaction of patients following this type of surgery. Hohenberger et al. found that in carcinomas of the lower third of the rectum, the application of abdomino-peranal intersphincteric resection can reduce the need for rectal excision by 20%. Neo-/adjuvant radiochemotherapy is required to reduce locoregional recurrence to an acceptable level [26]. These findings are consistent with our own

The "father" of intersphincteric resections, Schiessel states that in a study consisting of 121 patients, the technique has satisfactory long-term results not only in functional and oncologic respects, but also states that an important aspect is the preoperative correct staging of cases. Preoperative imaging consisting of MRI, sphincter manometry is mandatory. Case selection

Intersphincteric resections seem to be a feasible option in highly selected cases with low rectal

Functional outcomes are satisfactory following ISR from the patient's point of view.

cancer that refuse the presence of a colostomy bag be it a temporary one.

Oncologic outcome is like that of classic procedures.

of major surgery.

**4. Discussions**

findings in our relatively small group.

**Figure 10.** Local recurrence at 6 months following surgery.

is the key to success [27].

**5. Conclusions**

There were no perioperative complications and no hospital mortality was present. What we consider a minor complication was noted in the case of five patients at ~10 days following surgery in the form of a muco-submucosal necrosis at the level of the pulled throw colonic segment [25], complication treated in an ambulatory setting, without the need of anesthesia. This complication is probably due to mucosal ischemia. We recorded no wound infections/ wound dehiscence or intra-abdominal abscess. None of the patients developed anastomotic leakage or required a second surgery.

At 3 months after surgery, patients had no signs of local tumor recurrence on clinical exam and imaging (MR). CEA and CA 19-9 levels were still elevated in the case of 22 patients 3 months following surgery. The Wexner score obtained at this time showed a median value of **13.2**. The patients subjectively reported a relatively unsatisfactory continence especially in the case of gas.

At 6 months following surgery, only three patients had elevated CEA and CA 19-9 levels. Clinical exam and imaging invalidated the presence of local relapse or the existence of metastatic disease except for one case that presented with sacrum local recurrence (**Figure 10**) that required removal. The Wexner score obtained at this time showed a median value of **9.7**. Subjectively, patients reported a satisfactory continence with few episodes/week of especially gas incontinence.

At 12 months postoperative all patients showed normal CEA and CA 19-9 values. Clinical exam and follow-up imaging invalidated the presence of local relapse or existence of metastatic Quality of Life Following Intersphincteric Resections for Low Rectal Cancer: Early Results http://dx.doi.org/10.5772/intechopen.79727 119

**Figure 10.** Local recurrence at 6 months following surgery.

disease. The median Wexner score was **8.2** in the case of these patients, and they declared that they are satisfied regarding the choice of surgery and the level of continence, under the terms of major surgery.

## **4. Discussions**

**3. Results**

118 Cancer Survivorship

following surgery.

the case of gas.

gas incontinence.

leakage or required a second surgery.

**Figure 9.** Colo-cutaneous hand-sewn anastomosis.

The medium hospital stay was 9 days. Bowel movement resumed on the first or second day

There were no perioperative complications and no hospital mortality was present. What we consider a minor complication was noted in the case of five patients at ~10 days following surgery in the form of a muco-submucosal necrosis at the level of the pulled throw colonic segment [25], complication treated in an ambulatory setting, without the need of anesthesia. This complication is probably due to mucosal ischemia. We recorded no wound infections/ wound dehiscence or intra-abdominal abscess. None of the patients developed anastomotic

At 3 months after surgery, patients had no signs of local tumor recurrence on clinical exam and imaging (MR). CEA and CA 19-9 levels were still elevated in the case of 22 patients 3 months following surgery. The Wexner score obtained at this time showed a median value of **13.2**. The patients subjectively reported a relatively unsatisfactory continence especially in

At 6 months following surgery, only three patients had elevated CEA and CA 19-9 levels. Clinical exam and imaging invalidated the presence of local relapse or the existence of metastatic disease except for one case that presented with sacrum local recurrence (**Figure 10**) that required removal. The Wexner score obtained at this time showed a median value of **9.7**. Subjectively, patients reported a satisfactory continence with few episodes/week of especially

At 12 months postoperative all patients showed normal CEA and CA 19-9 values. Clinical exam and follow-up imaging invalidated the presence of local relapse or existence of metastatic Although intersphincteric resections are relatively "new to the surgeon's arsenal" numerous studies have been published regarding its effectiveness and overall satisfaction of patients following this type of surgery. Hohenberger et al. found that in carcinomas of the lower third of the rectum, the application of abdomino-peranal intersphincteric resection can reduce the need for rectal excision by 20%. Neo-/adjuvant radiochemotherapy is required to reduce locoregional recurrence to an acceptable level [26]. These findings are consistent with our own findings in our relatively small group.

The "father" of intersphincteric resections, Schiessel states that in a study consisting of 121 patients, the technique has satisfactory long-term results not only in functional and oncologic respects, but also states that an important aspect is the preoperative correct staging of cases. Preoperative imaging consisting of MRI, sphincter manometry is mandatory. Case selection is the key to success [27].
