Abstract: ObjectiveThe purpose of this study was to identify clinicopathological factors affecting the choice of intersphincteric resection (ISR). MethodsThis retrospective study analyzed records of 156 consecutive patients with anorectal cancer (≤5cm above the anal verge or ≤3cm above the dentate line) from January 2006 to June 2008. Patients were operated by the same group of surgeons. Variables analyzed included age, sex, differentiation, tumor distance to anal verge, pathological T, N, TNM and clinical stages (staging based on digital rectal examination) and neo-adjuvant therapy. ResultsThe number of patients who underwent ISR or not were 63 and 93, respectively. In the univariate analysis, significant factors were pathological T (P=0.038), N (P=0.044) and clinical (P<0.001) stages. The multivariate analysis showed that pathological T (P=0.027), N (P=0.016) and clinical (^P<0.001) stages were independently associated with the choice of ISR. ConclusionWhen faced with a patient with anorectal cancer, the decision to perform ISR is determined by local infiltration and involvement of lymph nodes, regardless of tumor distance, differentiation or neoadjuvant therapy. Digital rectal examination remains a useful method in ISR decision-making.