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ORIGINAL ARTICLE
            Laparoscopic Intersphincteric Resection and Colon Shaping

            for Low Rectal Cancer Treatment


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            Truong Van Nguyen , Minh Quang Dao , Hoa Lam Nguyen , Quyet Van Ha , Thuong Van Pham , Phuoc Van Nguyen ,
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            Thang Quyet Tran , Anh Thuy Tran 8
             AbstrAct
             Aim and objective: This paper was conducted to examine the results of laparoscopic intersphincteric resection and colon shaping for low
             rectal cancer treatment in adults.
             Materials and methods: Data were collected, including general characteristics, preoperative and postoperative characteristics, and long-term
             treatment outcomes. The Kaplan–Meier survival analysis was performed to assess the survival rate of 48 months after surgery.
             Results: Of 43 patients with low rectal cancer, subtotal intersphincteric resection was the primary surgical method at 37.2%. The colon was
             mainly shaped “J” at 51.2% of the patients. According to Kirwan classification, there were 83.7% of the patients at grade I; and this rate decreased
             to 62.9% after surgery (p <0.05). According to Wexner score, before surgery, 62.8% of the patients had a score <5, which reduced to 48.8% after
             surgery (p >0.05). The mean survival time was 41.53 ± 2.37 months, with a cumulative survival probability of 48 months of 78.8%. There was
             no difference in survival rate between patients with different stages of cancer and colon shaping.
             Conclusion: Laparoscopic intersphincteric resection and colon shaping were effective in low rectal cancer treatment. Colon shaping was an
             effective method of improving bowel function in cases of subtotal or total intersphincteric resection.
             Keywords: Colon shaping, Laparoscopic surgery, Low rectal cancer.
             World Journal of Laparoscopic Surgery (2021): 10.5005/jp-journals-10033-1473


            IntroductIon                                       1,2 Department of General Surgery, Thanh Nhan Hospital, Hanoi, Vietnam
            Low rectal cancer is malignancy, accounting for a high rate of about   3 Hai Phong Oncology Centre, Hai Phong University Medicine and
            40–45% of the colorectal cancer diseases. The common treatment   Pharmacy, Hanoi, Vietnam
            is multimodal therapies that combine surgery and adjuvant   4,5 Department of  Surgery,  Hai Phong  University of  Medicine  and
            therapy, with or without preoperative chemotherapy. In the early   Pharmacy, Hanoi, Vietnam
            20th century, Ernest Miles’ surgical method was considered the   6 Thanh Nhan Hospital, Hanoi, Vietnam
            standard approach for the treatment of low rectal cancer, with   7 Department of Obstetrics and Gynecology,  Thanh Nhan Hospital,
            abdominoperineal resection. 1,2                    Hanoi, Vietnam
               In the later stages, the treatment target for low rectal cancer has   8 Department of Functional  Test, National Hospital of  Traditional
            changed. In addition to the three primary goals of the treatment,   Medical, Hanoi, Vietnam
            including increasing survival, improving quality of life, and reducing   *
            recurrence rates, preserving the function of patients after treatment   Equally contributed to this manuscript
            has been set as a priority to ensure rectal cancer patients’ quality of   Corresponding Author: Truong Van Nguyen, Department of General
            life. In 1972, Park and Percy successfully performed sphincter-saving   Surgery, Thanh Nhan Hospital, Hanoi, Vietnam, e-mail: dr.truongnv@
            surgery. In 1982, Heald introduced a complete mesenterectomy   gmail.com
            and quickly became standard in rectal cancer surgery. Since then,   How to cite this article:  Nguyen  TV,  Dao  MQ,  Nguyen  HL,  et  al.
            the requirement to save sphincters has been prioritized in rectal   Laparoscopic Intersphincteric Resection and Colon Shaping for Low
            cancer treatment. 3,4                              Rectal Cancer Treatment. World J Lap Surg 2021;14(3):162–165.
               In 1984, based on the anatomical development of the anorectal   Source of support: Nil
            region and the discovery of the layer between the two sphincter   Conflict of interest: None
            muscles and the structure of the sphincter muscles, Rudolf Schiessel
            introduced the intersphincteric resection and colo-anal anastomosis
            by hand stitching. 5–7  In 2005, Schiessel et al. reported long-term   this period over open abdominal surgery, especially in abdominal/
            results, providing the foundation for intersphincteric resection   pelvic area surgery. Laparoscopic intersphincteric resection has
            in rectal cancer surgery. This study also mentioned sphincter   become the standard surgical method. 9
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            regeneration or using an artificial anal sphincter.  In 2010, Bujko et al.   However, after surgery for rectal tumors, bowel function
            published a study of 948 patients showing that a distance from 1 cm   often has disorders due to surgical intervention in the sphincter.
            or more from the tumor to the anal margin is sufficient to guarantee   Schiessel proposed a method of rectal shaping by the colon
            surgical success in terms of oncology. In the group of patients with a   to reduce the number of bowel movements while assessing
            distance of less than 1 cm or 5 mm, if the disease condition reaches   factors influencing the indications for colon shaping and factors
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            R0, the rate of local recurrence was 1.7% or lower.  In addition,   affecting the frequency of defecation after surgery.  This study
            laparoscopic surgery has been shown to have many advantages over   was conducted to evaluate the effectiveness of laparoscopic
            © The Author(s). 2021 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
            org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to
            the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain
            Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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