Intersphincteric resection with mesorectum excision and coloanal anastomosis

The tendency toward sphincter-preserving resection for distal rectal cancers has led in recent years to a revival of the technique of coloanal anastomosis (CAA). Our experience with intersphincteric resection in combination with CAA was reviewed with the aim of assessing morbidity, functional outcome, and cancer treatment results. A total of 119 patients treated for primary rectal cancer by CAA between 1978 and 1994 were studied retrospectively. Seventy-six percent of the tumors were located in the lower third of the rectum. There were 4 (3.3 %) deaths. The most common postoperative complications were urinary retention (13.5 %) and sexual dysfunction (17 %). There were 10 patients (8.4 %) with clinical anastomic leaks and 3 patients (2.5 %) with symptomatic stricture. General complications occured in 33 patients (28 %). The mean stool frequency was 2.2 per day. Twenty-three percent of patients reported 4 or more stools per day. Fecal continence was complete in 69 %, incontinence to gas in 10 %, minor leak in 17 % and major soiling in 4 %. Urgency occurred in 14 % and incomplete evacuation was present in 27 %. The cumulative local recurrence rate was 8.7 %, 5-year survival was 71 % (Dukes A 100 %, Dukes B 89 %, Dukes C 48 %). Interspincteric resection combined with CAA provides excellent treatment for low rectal cancers with long-term preservation of sphincter function and satisfactory local and distant tumor control.