Distal rectal cancer managed with intersphincteric resection and temporary ileostomy: A case report from a tertiary hospital in Ndola, Zambia

Abstract

Colorectal cancer ranks as the fourth leading cause of cancer-related deaths globally. Curative treatment for resectable disease is achieved through total mesorectal excision, which improves survival, reduces tumour recurrence, and results in an enhanced quality of life for survivors. The discovery that rectal cancer rarely extends beyond a distal resection margin of 1 cm has enabled sphincter preservation with acceptable continence and has modernized oncologic surgery practices through the adoption of intersphincteric resection (ISR). Neoadjuvant therapy—an integral part of the standard care when available —enables chemoreduction of locally advanced, very low rectal cancer, allowing for ISR. This report discusses a patient with distal rectal cancer, threatening but not invading the left levator muscle, treated with ISR at Ndola Teaching Hospital, Ndola, Zambia. The tumour was excised with a negative resection margin using total mesorectal excision principles via the ISR procedure, accompanied by a diverting ileostomy. Postoperatively, the patient underwent adjuvant chemoradiation therapy. Following ileostomy reversal, the patient exhibited good continence and continued follow-up at our national Cancer Diseases Hospital. According to national records, this represents Zambia’s first report of a patient treated with ISR.