Intersphincteric resection reduces local recurrence and improves five-year survival in lower rectal cancerIntersphincteric resection shows better outcomes for lower rectal cancer

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology Published October 2, 2026 Study authors: Ramezani Zahra, Madankan Ahmad, Baigi Vali, Alemrajabi Mahdi, Hasani Nazanin, Vaseghi Hamed, Mousavi… PubMed ↗ DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Consider ISR as a potential alternative to APR for lower rectal cancer, associated with lower recurrence and complications.

This meta-analysis evaluates the clinical outcomes of intersphincteric resection (ISR) compared to abdominoperineal resection (APR) in a population of 4502 patients with lower rectal cancer. The analysis synthesizes data on surgical outcomes, including local recurrence, complication rates, and long-term survival metrics.

Key findings indicate that ISR is associated with significantly lower rates of positive circumferential resection margins (RR: 0.41, p < 0.001) and fewer early postoperative complications (RR: 0.76, p < 0.001) compared to APR. Furthermore, ISR showed a lower risk of local recurrence (RR: 0.63, p = 0.0038). Long-term outcomes favored ISR, with a reported hazard ratio of 0.42 for five-year overall survival (p < 0.001) and a hazard ratio of 0.59 for five-year disease-free survival (p < 0.001).

A primary limitation of this evidence is that the included studies were retrospective in nature. While the data suggest ISR may be a safe and effective alternative to APR for selected patients, the retrospective design limits the ability to establish definitive causality. Clinical application should be based on patient-specific factors and surgical expertise.

How this fits prior evidence

This meta-analysis addresses the surgical management of lower rectal cancer. It provides data on surgical outcomes for ISR compared to APR, which complements existing evidence regarding the low toxicity of S-1 plus oxaliplatin consolidation in stage II/III lower rectal cancer patients.

When facing lower rectal cancer, the choice of surgical technique is a major decision. Doctors often weigh the benefits of different procedures to ensure the best recovery and long-term health. A large review of data involving over 4,500 patients compared two specific surgical methods: intersphincteric resection (ISR) and abdominoperineal resection (APR).

The findings suggest that ISR may offer several advantages. Patients who underwent ISR had lower rates of early complications and fewer instances of the cancer returning locally. The data also showed improved five-year survival rates and disease-free survival compared to those who had the APR procedure.

While these results are encouraging, it is important to note that the data came from retrospective studies, which look back at past cases. Because of this, the evidence is not as certain as a prospective trial. Doctors can still use this information to consider ISR as a potentially safer and more effective option for the right patients.

What this means for you:

Intersphincteric resection may lower complication rates and improve survival for some patients with lower rectal cancer.

Common questions

How does intersphincteric resection compare to abdominoperineal resection?

The analysis of 4,502 patients showed that intersphincteric resection (ISR) had lower rates of early postoperative complications and lower rates of local recurrence compared to abdominoperineal resection (APR). Additionally, patients who had ISR showed improved five-year overall survival and five-year disease-free survival.

Is intersphincteric resection safe for rectal cancer patients?

The data indicates that intersphincteric resection (ISR) is associated with a 24% reduction in early postoperative complications compared to the alternative. While it is considered a potentially safe and effective option for some patients, your doctor must determine if it is the right choice for your specific case.

What are the long-term benefits of the ISR procedure?

Patients who underwent intersphincteric resection (ISR) showed improved five-year overall survival and five-year disease-free survival. These results suggest that ISR may be a more effective way to manage the cancer over time compared to the abdominoperineal resection (APR) method.

Study Details

Study typeMeta analysis

Sample sizen = 4,502

EvidenceLevel 1

PublishedOct 2026

PMID42435723

View Original Abstract ↓

BACKGROUND: The optimal surgical approach for lower rectal cancer (LRC) remains debated, particularly between intersphincteric resection (ISR) and abdominoperineal resection (APR). While ISR offers potential sphincter preservation, its oncological efficacy compared to APR is unclear. METHODS: A systematic review was conducted to compare clinical and oncological outcomes of ISR versus APR in LRC patients. On December 8, 2024, a comprehensive search of Medline, Embase, Cochrane Library, Scopus, and Web of Science identified 24 retrospective studies involving 4502 patients. Key outcomes analyzed included positive circumferential resection margin (CRM), number of harvested lymph nodes (LNs), local recurrence (LR), length of hospital stay (LOS), early postoperative complications, and survival. RESULTS: Twenty-four retrospective studies involving 4502 patients (ISR: 2266 (50.3%) and APR: 1558 (34.6%)) met the eligibility criteria. ISR was associated with significantly lower rates of positive CRM (risk ratio (RR): 0.41, p < 0.001), decreased early postoperative complications (RR: 0.76, p < 0.001), lower LR (RR: 0.63, p = 0.0038), and improvement in five-year overall survival (5YOS) (hazard ratio (HR) = 0.42, p < 0.001) and five-year disease-free survival (5YDFS) (HR = 0.59, p < 0.001). CONCLUSIONS: ISR demonstrates several advantages over APR in selected LRC patients, including lower rates of positive CRM, fewer early postoperative complications, reduced LR, greater LN harvest, shorter LOS, and improved long-term survival outcomes (5YOS and 5YDFS). Therefore, ISR can be considered a safe and effective alternative to APR in appropriately chosen patients, with careful patient selection and surgical expertise remaining essential.

Intersphincteric resection reduces local recurrence and improves five-year survival in lower rectal cancerIntersphincteric resection shows better outcomes for lower rectal cancer

How this fits prior evidence

Common questions

Study Details

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Intersphincteric resection reduces local recurrence and improves five-year survival in lower rectal cancerIntersphincteric resection shows better outcomes for lower rectal cancer

How this fits prior evidence

Common questions

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