Intersphincteric Resection: A Stoma-Free Solution for Rectal Cancer with Improved Quality of Life

Patients facing rectal cancer should consult their healthcare provider to determine if ISR is a suitable option for their specific condition.

No one wants a stoma or a bag to collect body waste. Intersphincteric resection (ISR) has emerged as an innovative surgical approach for treating rectal cancer, offering numerous benefits to patients. This technique removes cancerous tissue while preserving the anal sphincter muscles, avoiding the need for a permanent stoma or bag and resulting in a higher quality of life after surgery. One of the most significant advantages of ISR is the avoidance of a stoma, leading to improved physical and emotional outcomes for patients. The introduction of robotic surgery has greatly enhanced the outcomes of ISR procedures.

Traditionally, these patients would have undergone abdominoperineal resection (APR), which involves removing the anus, creating a permanent bag, and requiring a much longer recovery time. In addition to the physical benefits of robotic ISR, the preservation of bowel function, early recovery, and avoidance of a stoma can significantly impact a patient’s emotional well-being. The use of a colostomy bag can be stigmatizing and uncomfortable, causing feelings of shame and embarrassment. Robotic ISR surgery aims to avoid the need for a permanent colostomy bag, allowing patients to maintain a sense of normalcy and avoid the psychological burden associated with a stoma. This can have a positive effect on a patient’s overall quality of life, resulting in improved mental health outcomes and long-term well-being.

The avoidance of a stoma through ISR is a significant advantage of this surgical technique, highlighting its potential to provide not only physical but also emotional relief. Robotic ISR is an organ-preserving surgical approach that offers excellent cancer treatment outcomes without compromising survival or recurrence rates. Patients eligible for ISR typically have tumours located in the lower third of the rectum, near the anus. These patients are typically offered APR, which results in a permanent bag. However, ISR can successfully be performed in approximately 90% of these patients, avoiding the need for a permanent bag. This procedure requires careful patient selection, pre-operative evaluation, and skilled surgical expertise. Often, patients end up with a permanent bag due to a lack of expertise. Centers that regularly perform this surgery at high volumes tend to achieve better results.

One such case treated was Mr. SM, a 43-year-old male from the northern part of Karnataka who was diagnosed with lower rectal cancer located 3 cm from the anus. He underwent radiation therapy initially, which is the standard treatment for most rectal cancers. When it came to surgery, he was offered APR, which would have required a permanent bag. It was at this point that he began exploring the possibility of saving the anus and avoiding a permanent bag. He learned about ISR and underwent the procedure with us, successfully returning home on the 4th day after surgery.

Studies have demonstrated that patients who undergo ISR experience improved continence and a lower risk of bowel dysfunction compared to traditional surgery. Patients undergoing ISR also report better quality of life post-surgery, with a reduced incidence of bowel symptoms and improved sexual function.

ISR is an innovative surgical technique that offers a safe and effective treatment option for patients with low rectal cancer. The avoidance of a stoma, preservation of bowel function, and improved quality of life make this technique a valuable option for eligible patients.

Patients facing rectal cancer should consult their healthcare provider to determine if ISR is a suitable option for their specific condition. With careful patient selection, pre-operative evaluation, and skilled surgical expertise, ISR can offer patients an optimal outcome, both physically and emotionally.

The above article is written by Dr. Sandeep Nayak P, Director – Department of Surgical Oncology & Robotic & Laparoscopic Surgery, Fortis Hospital, Bannerghatta Road, Bengaluru