{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T21:33:30Z","timestamp":1780090410231,"version":"3.54.0"},"reference-count":41,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2019,11,29]],"date-time":"2019-11-29T00:00:00Z","timestamp":1574985600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The objective of this article is to evaluate the long-term oncological and functional outcomes following modified intersphincteric resections (ISR) for low rectal cancer. The modified technique consisted of the abandonment of colonic J-pouches, transverse coloplasty, or defunctioning temporary stoma in favor of a direct handsewn coloanal anastomosis (CAA). Material and Methods: Sixty consecutive patients with type II and III (juxta-anal or intra-anal) low rectal tumors underwent modified ISR by the same surgical team and were followed for a period of five years. Functional outcomes using the Wexner Score, postoperative complications, recurrence rates, morbidity, and mortality rates were assessed. Results: The five-year survival rate was 93.3% with a disease-free interval at three years of 98%. Morbidity was 15% (n = 9) consisting of intestinal wall necrosis (n = 6), stenosis (n = 2), and sacral metastasis (n = 1). The Wexner score values were, at 1 year, 8.5 (range, 4\u201313); at three years 7.2 (range, 2\u201311); and at 5 years 6.7 (range, 2\u201312). A second surgery was needed in only one case that showed postoperative transmural necrosis of the colonic wall. Conclusions: In highly selected patients with type II or III low rectal tumors and proper preoperative imaging staging, ISR might be a viable alternative to other techniques such as abdominoperineal resection and low anterior resection, both from a functional and an oncological perspective.<\/jats:p>","DOI":"10.3390\/medicina55120764","type":"journal-article","created":{"date-parts":[[2019,11,29]],"date-time":"2019-11-29T10:58:21Z","timestamp":1575025101000},"page":"764","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Long Term Results of Modified Intersphincteric Resections for Low Rectal Cancer: A Single Center Experience"],"prefix":"10.3390","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9900-5375","authenticated-orcid":false,"given":"Vlad-Olimpiu","family":"Butiurca","sequence":"first","affiliation":[{"name":"First Department of Surgery, University of Medicine, Pharmacy, Science and Technology \u2018George Emil Palade\u2019, 540139 T\u00e2rgu-Mure\u0219, Romania"},{"name":"Clinic of Vascular Surgery, Emergency County Hospital, 540139 T\u00e2rgu-Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u0103lin","family":"Molnar","sequence":"additional","affiliation":[{"name":"First Department of Surgery, University of Medicine, Pharmacy, Science and Technology \u2018George Emil Palade\u2019, 540139 T\u00e2rgu-Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Copotoiu","family":"Constantin","sequence":"additional","affiliation":[{"name":"First Department of Surgery, University of Medicine, Pharmacy, Science and Technology \u2018George Emil Palade\u2019, 540139 T\u00e2rgu-Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian","family":"Botoncea","sequence":"additional","affiliation":[{"name":"First Department of Surgery, University of Medicine, Pharmacy, Science and Technology \u2018George Emil Palade\u2019, 540139 T\u00e2rgu-Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teodor Ioan","family":"Bud","sequence":"additional","affiliation":[{"name":"Clinic of Vascular Surgery, Emergency County Hospital, 540139 T\u00e2rgu-Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zsolt","family":"Kovacs","sequence":"additional","affiliation":[{"name":"Department of Pathology, Emergency County Hospital, 540136 T\u00e2rgu-Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4466-6360","authenticated-orcid":false,"given":"C\u0103t\u0103lin","family":"Satala","sequence":"additional","affiliation":[{"name":"Department of Pathology, Emergency County Hospital, 540136 T\u00e2rgu-Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3968-5118","authenticated-orcid":false,"given":"Simona","family":"Gurzu","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Medicine, Pharmacy, Science and Technology, 540139 T\u00e2rgu-Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,11,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.1002\/bjs.1800810944","article-title":"Intersphincteric resection for low rectal tumours","volume":"81","author":"Schiessel","year":"1994","journal-title":"Br. J. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1016\/S0140-6736(86)91510-2","article-title":"Recurrence and survival after total mesorectal excision for rectal cancer","volume":"327","author":"Heald","year":"1986","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1056\/NEJMoa010580","article-title":"Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer","volume":"345","author":"Kapiteijn","year":"2001","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1002\/bjs.9811","article-title":"Tumour regression in the randomized Stockholm III trial of radiotherapy regimens for rectal cancer","volume":"102","author":"Pettersson","year":"2015","journal-title":"Br. J. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/S1470-2045(14)71199-4","article-title":"Adjuvant chemotherapy after preoperative (chemo) radiotherapy and surgery for patients with rectal cancer: A systematic review and meta-analysis of individual patient data","volume":"16","author":"Breugom","year":"2015","journal-title":"Lancet Oncol."},{"key":"ref_6","first-page":"iv22","article-title":"Arnold, on behalf of the ESMO Guidelines Committee, Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"28","author":"Wyrwicz","year":"2017","journal-title":"Ann. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.2214\/AJR.08.1298","article-title":"MRI for detection of extramural vascular invasion in rectal cancer","volume":"191","author":"Smith","year":"2008","journal-title":"Am. J. Roentgenol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1016\/S1470-2045(09)70084-1","article-title":"Defining the surgical planes on MRI improves surgery for cancer of the low rectum","volume":"10","author":"Shihab","year":"2009","journal-title":"Lancet Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1097\/DCR.0b013e31827c4a8c","article-title":"Low rectal cancer: Classification and standardization of surgery","volume":"56","author":"Rullier","year":"2013","journal-title":"Dis. Colon Rectum"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1097\/01.sla.0000154551.06768.e1","article-title":"Sphincter-saving resection for all rectal carcinomas: The end of the 2-cm distal rule","volume":"241","author":"Rullier","year":"2005","journal-title":"Ann. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Davila, G.W., Ghoniem, G.M., and Wexner, S.D. (2006). Scoring Systems. Pelvic Floor Dysfunction, Springer.","DOI":"10.1007\/b136174"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1016\/j.crad.2014.01.010","article-title":"The prognostic significance of MRI-detected extramural venous invasion in rectal carcinoma","volume":"69","author":"Bugg","year":"2014","journal-title":"Clin. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.2214\/AJR.08.1004","article-title":"A systematic approach to the interpretation of preoperative staging MRI for rectal cancer","volume":"191","author":"Taylor","year":"2008","journal-title":"Am. J. Roentgenol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4303","DOI":"10.1007\/s00330-016-4283-9","article-title":"Multiparametric MRI in the assessment of response of rectal cancer to neoadjuvant chemoradiotherapy: A comparison of morphological, volumetric and functional MRI parameters","volume":"26","author":"Tarlinton","year":"2016","journal-title":"Eur. Radiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1097\/SLA.0000000000001193","article-title":"Prospective validation of a low rectal cancer magnetic resonance imaging staging system and development of a local recurrence risk stratification model","volume":"263","author":"Battersby","year":"2016","journal-title":"Ann. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"MERCURY Study Group (2006). Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: Prospective observational study. Br. Med. J., 333, 779\u2013782.","DOI":"10.1136\/bmj.38937.646400.55"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Ma, X., Li, X., Xu, L., Shi, D., Tong, T., Huang, D., and Peng, J. (2015). Characteristics and prognostic significance of preoperative magnetic resonance imaging-assessed circumferential margin in rectal cancer. Gastroenterol. Res. Pract.","DOI":"10.1155\/2015\/410150"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1148\/radiology.211.1.r99ap35215","article-title":"Rectal carcinoma: Thin-section MR imaging for staging in 28 patients","volume":"211","author":"Brown","year":"1999","journal-title":"Radiology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1001\/archsurg.133.8.894","article-title":"Rectal cancer: The Basingstoke experience of total mesorectal excision, 1978\u20131997","volume":"133","author":"Heald","year":"1998","journal-title":"Arch. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/0140-6736(93)90207-W","article-title":"Mesorectal excision for rectal cancer","volume":"341","author":"MacFarlane","year":"1993","journal-title":"Lancet"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/S1470-2045(11)70097-3","article-title":"Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial","volume":"12","author":"Marijnen","year":"2011","journal-title":"Lancet Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1177\/0300060518758841","article-title":"Survival and functional and oncological outcomes following intersphincteric resection for low rectal cancer: Short-term results","volume":"46","author":"Molnar","year":"2018","journal-title":"J. Int. Med. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1186\/s12957-018-1513-4","article-title":"A quest for sphincter-saving surgery in ultralow rectal tumours\u2014A single-centre cohort study","volume":"16","author":"Rubinkiewicz","year":"2018","journal-title":"World J. Surg. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"167","DOI":"10.3393\/ac.2018.08.02","article-title":"Intersphincteric Resection for Patients with Low-Lying Rectal Cancer: Oncological and Functional Outcomes","volume":"34","author":"Park","year":"2018","journal-title":"Ann. Coloproctol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1111\/j.1463-1318.2010.02528.x","article-title":"Intersphincteric resection for low rectal cancer: Laparoscopic vs open surgery approach","volume":"14","author":"Laurent","year":"2012","journal-title":"Colorectal Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1245\/s10434-014-4085-8","article-title":"Laparoscopic transabdominal approach partial intersphincteric resection for low rectal cancer: Surgical feasibility and intermediate-term outcome","volume":"22","author":"Chi","year":"2015","journal-title":"Ann. Surg. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1186\/s12957-017-1304-3","article-title":"Laparoscopic intersphincteric resection versus an open approach for low rectal cancer: A meta-analysis","volume":"15","author":"Chen","year":"2017","journal-title":"World J. Surg. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1016\/j.amjsurg.2008.08.005","article-title":"How important is rigid proctosigmoidoscopy in localizing rectal cancer?","volume":"196","author":"Schoellhammer","year":"2008","journal-title":"Am. J. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1002\/ags3.12003","article-title":"Intersphincteric resection for very low rectal cancer: A review of the updated literature","volume":"1","author":"Shirouzu","year":"2017","journal-title":"Ann. Gastroenterol. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1007\/s00595-012-0394-3","article-title":"Intersphincteric resection for very low rectal cancer: A systematic review","volume":"43","author":"Akagi","year":"2013","journal-title":"Surg. Today"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Spanos, C.P. (2012). Intersphincteric resection for low rectal cancer: An overview. Int. J. Surg. Oncol.","DOI":"10.1155\/2012\/241512"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1002\/bjs.8677","article-title":"Systematic review of outcomes after intersphincteric resection for low rectal cancer","volume":"99","author":"Martin","year":"2012","journal-title":"Br. J. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1097\/00000658-199607000-00009","article-title":"Randomized comparison of straight and colonic J pouch anastomosis after low anterior resection","volume":"224","author":"Krog","year":"1996","journal-title":"Ann. Surg."},{"key":"ref_34","first-page":"1449","article-title":"Late clinical outcome in a randomized prospective comparison of colonic J pouch and straight coloanal anastomosis","volume":"84","author":"Lazorthes","year":"1997","journal-title":"Br. J. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/S1091-255X(01)80027-5","article-title":"Long-term prospective assessment of functional results after proctectomy with coloanal anastomosis","volume":"5","author":"Fichera","year":"2001","journal-title":"J. Gastrointest. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1159\/000332007","article-title":"Short-term outcomes of laparoscopic intersphincteric resection for lower rectal cancer and comparison with open approach","volume":"28","author":"Yamamoto","year":"2011","journal-title":"Dig. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/BF02237236","article-title":"Fecal incontinence quality of life scale","volume":"43","author":"Rockwood","year":"2000","journal-title":"Dis. Colon Rectum"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1136\/gut.44.1.77","article-title":"Prospective comparison of faecal incontinence grading systems","volume":"44","author":"Vaizey","year":"1999","journal-title":"Gut"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.jcol.2017.06.008","article-title":"Fecal incontinence and quality of life assessment through questionnaires","volume":"37","author":"Rodrigues","year":"2017","journal-title":"J. Coloproctol. (Rio de Janeiro)"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"S13","DOI":"10.1007\/s10350-006-0598-y","article-title":"Intersphincteric resection in patients with very low rectal cancer: A review of the Japanese experience","volume":"49","author":"Saito","year":"2006","journal-title":"Dis. Colon Rectum"},{"key":"ref_41","first-page":"123","article-title":"Comparison of outcomes following intersphincteric resection vs low anterior resection for low rectal cancer: A systematic review","volume":"39","author":"Ursi","year":"2018","journal-title":"Il Giornale di Chirurgia"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/55\/12\/764\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:38:44Z","timestamp":1760189924000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/55\/12\/764"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,29]]},"references-count":41,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2019,12]]}},"alternative-id":["medicina55120764"],"URL":"https:\/\/doi.org\/10.3390\/medicina55120764","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,29]]}}}