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Intersphincteric resection(ISR) has been performing in patients with very low-lying rectal cancer forpreservation of anal function. We investigated risk factors associated withprognosis in patients undergoing ISR.Data from 150 patients with very low rectal cancer who underwent curative resection between 2000 and 2007 were analyzed. Patients were stratified according to: ISR and ISR with patient's external sphincter resection (PESR) groups; T1/T2(£T2) and T3/T4(‡T3) groups, R0(radial margin > 1 mm) and R1(£1 mm) groups. Survival and local recurrence were investigated in these groups.Five-year disease-free survival rate was 93% in £T2 group and 65% in ‡T3 group (P < 0.05), 76% in ISR and 52% in ISR with PESR group(P < 0.001). The 5-year local relapse-free survival rate was 87% in ISR and R0 groups, 75% in ISR with PESR and R1 groups (P < 0.05). These was also significant deference in the 5-years overall survival between R0 and R1 groups (P < 0.05).R1, ISR with PESR, and ‡T3 group are associated with worseprognosis in this curative operation. Powerfulpreoperative and postoperative adjuvant therapy may be needed in these groups.