Intersphincteric Resection for Low Rectal Cancer: A Review of Anatomy and Surgical Techniques, Oncologic and Functional Outcomes and the Role of Robotics

Intersphincteric resection (ISR) for low rectal cancer is a relatively novel anal-sparing technique that requires a thorough knowledge of the anatomy of the deep pelvic space and advanced surgical skills.The development of laparoscopic intersphincteric resection, through magnification of the surgical field, has renewed the interest in the anatomical description of the anal canal and deep pelvis, which has been historically fraught with inconsistencies.Introduction of the robotic platform has made the deep pelvis technically accessible to a greater number of colorectal surgeons.The literature describes ISR as an oncologically safe technique with good functional outcomes; however, there is often confusion regarding its definition, indications and technical aspects of this challenging procedure.This review aims to evaluate the current state of robotic ISR through the discussion of novel detailed anatomical descriptions, surgical techniques and indications, together with oncological and functional results.