International standardization and optimization group for intersphincteric resection (ISOG-ISR): modified Delphi consensus on anatomy, definition, indication, surgical technique, specimen description and functional outcome

Guglielmo Niccolò Piozzi, Krunal Khobragade, Vusal Aliyev, Oktar Asoglu, Paolo Pietro Bianchi, Vlad Olimpiu Butiurca, William Tzu Liang Chen, Ju Yong Cheong, Gyu Seog Choi, Andrea Coratti, Quentin Denost, Yosuke Fukunaga, Emre Gorgun, Francesco Guerra, Masaaki Ito, Jim S. Khan, Hye Jin Kim, Jin Cheon Kim, Yusuke Kinugasa, Tsuyoshi KonishiLi Jen Kuo, Mehmet Ayhan Kuzu, Jeremie H. Lefevre, Jin Tung Liang, John Marks, Călin Molnar, Yves Panis, Philippe Rouanet, Eric Rullier, Avanish Saklani, Antonino Spinelli, Petr Tsarkov, Shunsuke Tsukamoto, Martin Weiser, Seon Hahn Kim

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Aim: Intersphincteric resection (ISR) is an oncologically complex operation for very low-lying rectal cancers. Yet, definition, anatomical description, operative indications and operative approaches to ISR are not standardized. The aim of this study was to standardize the definition of ISR by reaching international consensus from the experts in the field. This standardization will allow meaningful comparison in the literature in the future. Method: A modified Delphi approach with three rounds of questionnaire was adopted. A total of 29 international experts from 11 countries were recruited for this study. Six domains with a total of 37 statements were examined, including anatomical definition; definition of intersphincteric dissection, intersphincteric resection (ISR) and ultra-low anterior resection (uLAR); indication for ISR; surgical technique of ISR; specimen description of ISR; and functional outcome assessment protocol. Results: Three rounds of questionnaire were performed (response rate 100%, 89.6%, 89.6%). Agreement (≥80%) reached standardization on 36 statements. Conclusion: This study provides an international expert consensus-based definition and standardization of ISR. This is the first study standardizing terminology and definition of deep pelvis/anal canal anatomy from a surgical point of view. Intersphincteric dissection, ISR and uLAR were specifically defined for precise surgical description. Indication for ISR was determined by the rectal tumour's maximal radial infiltration (T stage) below the levator ani. A new surgical definition of T3isp was reached by consensus to define T3 low rectal tumours infiltrating the intersphincteric plane. A practical flowchart for surgical indication for uLAR/ISR/abdominoperineal resection was developed. A standardized ISR surgical technique and functional outcome assessment protocol was defined.

Original languageEnglish
Pages (from-to)1896-1909
Number of pages14
JournalColorectal Disease
Volume25
Issue number9
DOIs
Publication statusPublished - Sept 2023

Keywords

  • abdominoperineal resection
  • Delphi study
  • intersphincteric resection
  • rectal cancer
  • surgical anatomy
  • ultra-low anterior resection

ASJC Scopus subject areas

  • Gastroenterology

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