Intersphincteric Resection with Preservation of Anal Sensation for Cancer of the Ano-Rectal Junction

Introduction: The aim of this study was to evaluate morbidity, oncolgic and functional outcome of the Intersphincteric resection with preservation of the anal sensation through saving part of the anal canal followed by low coloanal anastomosis for carcinoma of the Ano-rectal junction. Methods: From January 1996 December 2005, Twenty two patients were studied in a prospective trial. All patients had an infiltrating adenocarcinoma (10 T2 and 12 T3), twelve patients had preoperative radiation therapy and concomitant chemotherapy, and eight patients received adjuvant chemotherapy. All patients underwent Intersphincteric resection with preservation of anal sensation by sparing nearly half of the anal canal with the pectinate line. Results: Male: Female ratio was 1.8:1. Tumors were located between 2.5-4.5 (mean 3.6) cm from the anal verge There was one case of postoperative mortality due to septicemia from anaerobic pelvic sepsis. The surgical morbidity occurred in two patients in whom anastomotic leakage occurred, one healed spontaneously on conservative measures, the other underwent temporary colostomy. After immediate follow-up of 72 (range: 24-120) months, local recurrence rate was documented in 9% of patients. One patient died of distant metastasis. The Five year actuarial survival rate was 79%. Continence was assessed subjectively according to Kirwan scale, 80% of patients were continent (Kirwan scale: 1) while four patients suffered from minor soiling. Conclusion: The preliminary results suggest the technique may be considered a valid alternative to abdominoperineal resection for selected rectal tumors situated at the Ano-rectal junction.