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 PiozziKrunal KhobragadeVusal AliyevOktar AsogluPaolo Pietro BianchiVlad-Olimpiu ButiurcaWilliam Tzu-Liang ChenJu Yong CheongGyu-Seog ChoiAndrea CorattiQuentin DenostYosuke FukunagaEmre GorgunFrancesco GuerraMasaaki ItoJim S KhanHye Jin KimJin Cheon KimYusuke KinugasaTsuyoshi KonishiLi-Jen KuoMehmet Ayhan KuzuJérémie H LefevreJin-Tung LiangJohn H MarksCălin MolnarYves PanisPhilippe RouanetEric RullierAvanish P SaklaniAntonino SpinelliPetr V TsarkovShunsuke TsukamotoMartin R WeiserSeon Hahn KimPublished in: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland (2023)
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.