Morbidity and oncological outcomes after intersphincteric resection of the rectum for low-lying rectal cancer: experience of a single center in a lower-middle-income country

Sep 24, 2026

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Intersphincteric resection (ISR) with colo-anal anastomosis for low-lying rectal cancer aims to maintain bowel continuity and avoid permanent stomas. This observational single-center study from prospectively stored data evaluated morbidity, mortality, and oncological outcomes, including local recurrence at one year, in patients treated between July 2014 and June 2021. Among 102 patients, intra-operative complications occurred in 6% and 30-day complications in 41%, with early mortality risk 12.7% and local recurrence in 9 patients.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Background

Colorectal cancer burden and rectal proportion

Evolution of rectal cancer surgery and sphincter preservation

Rationale for distal resection margins and avoiding permanent colostomy

Bediako‑Bowan etal. BMC Surgery (2023) 23:39 [https://doi.org/10.1](https://doi.org/10.1) 186/s12893‑023‑01940‑9 BMC Surgery RESEARCH Open Access Morbidity and oncological outcomes after intersphincteric resection of the rectum for low‑lying rectal cancer: experience of a single center in a lower‑middle‑income country Antoinette Afua Asiedua Bediako‑Bowan 1,2,3*, Narious Naalane2 and Jonathan C. B. Dakubo 1,2,3 Abstract Background Intersphincteric resection (ISR) of the rectum for low‑lying rectal cancer with colo‑anal anastomosis was introduced years ago, allowing for bowel continuity, and avoiding permanent stomas. The colorectal unit of Korle Bu Teaching Hospital adopted this procedure in 2014 when indicated, for the management of rectal cancers, where hitherto, abdominoperineal resection of the rectum with a permanent stoma was indicated. This study aimed to assess morbidity, mortality, and oncological outcomes associated with ISR of the rectum and determine the factors contributing to these. Methods This was an observational study from prospectively stored data. All patients who underwent intersphinc‑ teric resection of the rectum due to low‑lying rectal cancer from July 2014 to June 2021 were included in the study, and their records were assessed for intra‑operative and 30‑day postoperative complications, as well as mortality and their related risk factors and their oncological outcomes in terms of local recurrence at one year. Results 102 patients were included in this analysis. Six percent (6/102) of patients had intra‑operative complications, including bleeding, and 41%(42/102) had 30‑day postoperative complications, which were associated with pelvic side wall attachment of tumor and intra‑op complications. Mortality risk was 12. 7%(13/102) in the early postoperative period, and nine patients had a local recurrence within the first year of surgery. Conclusion There is a high risk of early postoperative morbidity and mortality after intersphincteric resection of the rectum in our setting. The oncological outcomes are favorable in a population that abhors a permanent colostomy. Keywords Rectal cancer, Intersphincteric resection of rectum, Surgery, Local recurrence, Complications *Correspondence: Antoinette Afua Asiedua Bediako‑Bowanabediako‑[bowan@ug.edu.gh](bowan@ug.edu.gh) 1 Department of Surgery, University of Ghana Medical School, University of Ghana, P. O. Box 4236, Accra, Ghana 2 Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana 3 Mwin Tuba Hospital and Coloproctology Centre, Accra, Ghana Background Cancers of the large bowel are a significant cause of morbidity and mortality, being the third most typical cancer diagnosed and the second cause of cancer-related deaths worldwide, with an estimated 1.9 million new cases and 915,880 deaths [1–4]. The incidence distribution of CRC in the bowel is; a third each for the right colon, left colon, and rectum [5]. In developing countries, close to 50% of © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ()[. The Creati

FAQs

What is intersphincteric resection (ISR) intended to achieve for low-lying rectal cancer?

ISR of the rectum with colo-anal anastomosis is intended to preserve bowel continuity while avoiding permanent stomas.

How were patients and outcomes assessed in this study?

Patients undergoing ISR for low-lying rectal cancer from July 2014 to June 2021 were included from prospectively stored data, and records were reviewed for intra-operative and 30-day postoperative complications, mortality, and oncological outcomes such as local recurrence at one year.

What key results were reported for complications, mortality, and recurrence?

In this analysis of 102 patients, 6% had intra-operative complications and 41% had 30-day postoperative complications, with early postoperative mortality risk of 12.7%. Local recurrence within the first year occurred in 9 patients.

Sep 24, 2026

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