Intersphincteric resection is a technique that allows for sphincter-preserving surgery for rectal cancers located 1-2 cm from the anal verge. The procedure involves partial resection of the internal anal sphincter while completely preserving the external anal sphincter. A study of 90 patients who underwent this surgery found that 82% had 5-year overall survival and 75% had 5-year disease-free survival. While 41% had perfect post-operative continence, 76% reported overall subjective satisfaction with functional results. Preoperative radiotherapy was associated with worse functional outcomes.

1. Ultralow resections Emmanuel Tiret Hôpital Saint-Antoine, AP-HP Université Pierre et Marie Curie, Paris VI

5. Circumferential incision of the anal mucosa with special attention to preserve a sufficient length of anoderm. After circumferential preparation the rectum is mobile and the external sphincter has been completely preserved. Surgical technique Schiessel et al. Dis Colon Rectum 2005; 48: 1858–1867

6. A coloanal anastomosis is performed with single sutures taking the anus and parts of the external anal sphincter Surgical technique

10. Intersphincteric resections 1992-2004 : 6% of 1319 rectal adenocarcinoma

12. upper third : upper half or > : 63 (70%) 27 (30%) Level of internal sphincter excision T Median distal resection margin : 12mm (5-35)

16. Characteristics of 6 patients with local recurrence and 2 patients with combined recurrence Ann Surg 2007; 246: 916-22

17. Survival Five-years overall survival 82% IC 95% [80-97] Five-years disease free survival 75% IC 95%[64-86] Death from cancer : 14.4% (13)

18. Recurrence and survival Author n Stage Follow-up (months) Local recurrence Distant recurrence Survival Schiessel 121 T1-4 94 5.3% Köhler 31 T1-3 82 10% 10% 79% Rullier 92 T1-4 44 2% 19% 81% Saito 225 T1-3 41 6.7% 91.9% Braun 63 T1-3 80 11% 33% 62% * Hohenberger St Antoine 53 90 T1-4 56.2 25.1% 6.6% 8.8% 85% 82%

22. Manometry Schiessel et al. Dis Colon Rectum 2005; 48: 1858–1867 n = 117 IRS Relationship between level of coloanal anastomosis and complete continence

23. Factors influencing functional outcome Univariate analysis Chamlou R et al. Ann Surg 2007; 246: 916-22

25. Functional result Author n Stool frequency n/24h Normal continence Major incontinence Colostomy Schiessel 117 3 86.3% 0% 0 Köhler 26 3-4 29.6% 3.7% 1 Bretagnol 40 2.5 15% 12% 0 Saito 181 3-4 68% 7% 0 Braun 41 2.2 80% 3% 0 St Antoine 83 2.3 41% 2% 0