全国アンケート調査からみた下部直腸がんに対する括約筋間切除術の 術後排便障害の発生の現状と問題点

Purpose: The aim of this study was to analyze the current status of intersphincteric resection (ISR) for lower rectal cancer and the issue of post-resection anorectal dysfunction in Japan, based on the results of a questionnaire. Materials and Methods: A questionnaire was distributed to 441 facilities in Japan approved by the Japan Society of Coloproctology. Result: The response rate was 39% (172 facilities). Eighty-eight (51%) facilities performed ISR procedures during the survey period. In 62/88 (70%) facilities, less than 5 patients underwent an ISR procedure. A diverting stoma was created following ISR in almost all of the facilities. In 52% of 142 responding facilities, the diverting stoma could not be reversed because of issues including recurrence, problems associated with anastomosis, and anal sphincter-related dysfunction; thus, a permanent stoma remained. In addition, about 90% of 142 responding facilities reported that patients had anorectal dysfunction, even though they were followed for over 2 years after diverting stoma reversal. In 81% of the facilities, patients had fecal incontinence. Fecal incontinence after ISR was associated with resection volume of the internal anal sphincter muscle, anastomosis-related issues, age, radiation therapy, and gender. Most of the responding facilities reported that 20%-30% of patients who underwent ISR had fecal incontinence, followed by 50%, almost all, and 70%-80%, with frequencies of 41%, 20%, 12%, and 8%, respectively. Regarding treatment of anorectal dysfunction, the surgeon alone provided treatment in almost all facilities. Many patients were treated with medication, although various treatments were used. Conclusion: This survey analysis found that patients in many facilities had a diverting stoma that could not be reversed after ISR, and in some patients, severe anorectal dysfunction occurred after ISR. Surgeons should understand the risks associated with an ISR procedure, including the possibility of anorectal dysfunction following ISR. When choosing an ISR procedure for lower rectal cancer, surgeons must perform the procedure properly, upon obtaining informed consent.