Clinical Efficacy and Pathological Outcomes of Transanal Endoscopic Intersphincteric Resection for Low Rectal Cancer

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Abstract Purpose Transanal endoscopic intersphincteric resection (ISR) surgery currently lacks sufficient clinical research and reporting. In this study, we present the surgical outcomes, perioperative complications, and pathological findings based on the transanal endoscopic ISR surgeries performed in our center, aiming to contribute to the clinical application and development of this technique. Methods This study utilized a retrospective case series study design. Clinical and pathological data of patients with low rectal cancer who underwent transanal endoscopic ISR at the First Affiliated Hospital of Xiamen University from May 2018 to May 2023 were collected. All patients underwent transanal endoscopic ISR as the surgical approach. We conducted a study to report on the perioperative recovery status, postoperative complications, and pathological specimen characteristics of this group of patients. Results This study included a total of 45 eligible cases, with no perioperative deaths. The overall incidence of early complications was 22.22%, with a rate of 4.44% for Clavien-Dindo ≥ III. Two patients (4.4%) developed anastomotic leakage after surgery, including one case of grade A and one case of grade B. Postoperative pathological examination confirmed negative circumferential resection margin (CRM) and distal resection margin (DRM) in all patients. The distance between the tumor lower margin and DRM was found to be 2.30 ± 0.62 cm. Transanal endoscopic ISR surgery consistently yields excellent quality pathological specimens. Conclusions Transanal endoscopic ISR is safe and feasible, providing a clear anatomical view. It is associated with a low incidence of postoperative complications and achieves favorable pathological outcomes, making it worthy of further research and application.

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