Complete intersphincteric longitudinal muscle excision May Be key to reducing local recurrence during intersphincteric resection

被引：12
作者：
Kim, Jin Cheon [1 ,2 ,3 ]
Kim, Chan Wook [1 ,2 ,3 ]
Lee, Jong Lyul [1 ,2 ,3 ]
Yoon, Yong Sik [1 ,2 ,3 ]
Park, In Ja [1 ,2 ]
Kim, Jung Rang [1 ,2 ]
Kim, Jihun [2 ,4 ]
Park, Seong Ho [2 ,5 ]
机构：
[1] Univ Ulsan, Dept Surg, Coll Med, 88,Olymp Ro 43 Gil, Seoul 05505, South Korea
[2] Asan Med Ctr, 88,Olymp Ro 43 Gil, Seoul 05505, South Korea
[3] Asan Med Ctr, Inst Innovat Canc Res, Seoul 05505, South Korea
[4] Univ Ulsan, Dept Pathol, Coll Med, Seoul 05505, South Korea
[5] Univ Ulsan, Dept Radiol, Coll Med, Seoul 05505, South Korea
来源：
EJSO | 2021年 / 47卷 / 07期
关键词：
Rectal cancer; Robot-assisted; Intersphincteric resection; Oncological outcome; Total intersphincteric longitudinal muscle excision (TILME); RECTAL-CANCER; SURGERY; ANATOMY;
D O I：
10.1016/j.ejso.2020.12.017
中图分类号：
R73 [肿瘤学];
学科分类号：
100214 ;
摘要：
Background: Although total mesorectal excision (TME) is regarded as a standard procedure for rectal cancer, technical definition and evaluation method have not yet been investigated for intersphincteric resection (ISR). This study was performed to introduce a complete ISR procedure, and to assess whether total intersphincteric longitudinal muscle excision (TILME) facilitated the completeness of ISR and reduced recurrence. Methods: A total of 1080 patients with rectal adenocarcinoma who underwent robot-assisted low anterior resection (LAR) over 10 years were consecutively enrolled. Propensity-score matching of the two LAR groups (ISR vs LAR group, 1:1) and three ISR subgroups (partial vs subtotal vs total ISR subgroup, 2:2:1) was performed by strict adjustment of baseline characteristics. Archived specimens and video-/ photo-records were reevaluated to examine completeness of TILME. Results: Complete-TILME was performed in 84.5% of patients who underwent ISR. Multivariate analysis showed that incomplete-TILME was the only parameter independently associated with increased 5-year cumulative local recurrence (odds ratio = 23.385; 95% confidence interval = 1.492-366.421; p = 0.03), and that incomplete-TILME was independently associated with adipose tissue surrounding the intersphincteric longitudinal muscle, coloanal anastomosis, and total ISR (p < 0.001-0.05). Although mean incontinence scores and anorectal manometry deteriorated to some degree 12-24 months after surgery in all patients, they remained acceptable. The 5-year cumulative DFS (74.1% vs 60%, p = 0.18) and OS (85.9% vs 70%, p = 0.10) rates tended to be higher in patients with complete than incomplete-TILME. Conclusions: The completeness of TILME appears to be an independent indicator of complete ISR, reducing local recurrence following lower rectal cancer surgery. (c) 2021 Elsevier Ltd, BASO -The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
引用
收藏
页码：1629 / 1636
页数：8
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