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Invited Lecture (JSGS)
Sat. October 14th   14:00 - 14:40   Room 6: Fukuoka International Congress Center 203+204
Invited Lecture-12
TME and minimal invasive surgery on colorectal cancer outcomes of intersphincteric resection for lower rectal cancer
A. M. Lacy
Department of Surgery, Hospital Clinic University of Barcelona
 Transanal total mesorectal excision (TaTME) has risen as a growing approach for rectal cancer and its outcomes are still under evaluation. Intersphincteric resection (ISR) means a step beyond on the implementation of the transanal approach for rectal cancer.

Intersphinteric dissection was born as a solution for those tumors 5 cm from the anal verge or at least 1 cm from the anal ring. The approach was initially performed completely from the transabdominal field, including the section of the sphincters. But soon enough surgeons realized the sphinteric dissection should be performed transanally, as it implies a direct visualization of the lower edge tumor and the sphincteric complex and therefore a more accurate evaluation of the distal margin of resection. Ultralow rectal cancer cases, which previously were candidates for an abdominoperineal resection, nowadays may be approached by a partial or total intersphinteric resection, following the modified classification by Rullier et al.

Intersphincteric dissection with a down-to-up total mesorectal excision is the natural evolution of the ISR and the TaTME techniques. First approach of the tumor from the transanal field may be either open or laparoscopic with the platform already in place. Anatomy of the sphincteric complex, pelvic floor and mesorectum is crucial for an adequate dissection. Combined transanal and transabdominal approach (Cecil approach) improves the surgical performance. Experts groups are starting to report their short and mid-term results. On our experience, over 20 cases of ISR have been performed, including T1 to T4. Operative time average was 150 minutes (80-280). Hand-sewn anastomosis was performed in 84% of the cases, with a J-pouch constructed on 73% of the anastomosis. Complete mesorectum was found on 93% of the cases, with 26% presenting a positive CRM (<1mm) (n=4). Average number of lymph nodes harvested was 15.8 (range 9-33). There are no anastomotic leaks on this series and only two patients presented with a collection treated conservatively. There was no local recurrence, disease free-survival was 93% and overall survival was 100%, with an average follow-up of 5.8 months.

Evolution of the technique, step-by-step description, literature review and outcomes of the ISR are presented.
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