Intersphincteric resection with direct coloanal anastomosis for ultra-low rectal cancer：a report of 51 cases　              WEI Guang-hui, HAN Jia-gang, WANG Zhen-jun, et al. Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
Corresponding author: WANG Zhen-jun, E-mail: wang3zj@sohu.com
Abstract    Objective    To evaluate the complications, oncological and functional outcomes of intersphincteric resection (ISR) in ultra-low rectal cancer. Methods    From March 2000 to August 2009, ISR with total mesorectal excision was performed in 51 patients with very low rectal cancer (total ISR in 6 patients, partial ISR in 23 patients and modified partial ISR in 22 patients) in Department of General Surgery, Beijing Chaoyang Hospital of Capital Medical University. Results    Postoperative complications occurred in 9 patients, such as wound infection (2 patients), anastomotic leakage (2 patients), anastomotic stricture (4 patients) and pelvic abscess (1 patient), without perioperative mortality. The 5-year overall survival rate was 95%, and 5-year disease-free survival rate was 92%. Patients performed partial ISR (P= 0.008) and modified partial ISR (P=0.000) both had significantly better continence than those performed total ISR, and patients with diverting stoma had significantly better continence (P=0.022) than those without stoma at 12 months after operation. Conclusion    ISR is safe and feasible for ultra-low rectal cancer. Anastomotic stricture is the common postoperative complication of ISR. A temporary diverting stoma and modified partial ISR showed better anal function and less rate of incontinence.