Abdominoperineal resection

Abdominoperineal resection

An abdominoperineal resection, formally known as abdominoperineal resection of the rectum and abdominoperineal excision of the rectum or simply abdominoperineal excision, is a surgery for rectal cancer. It is frequently abbreviated as AP resection and APR.

Indication and description

The principal indication for AP resection is a rectal carcinoma situated in the lower third of the rectum. Other indications include recurrent or residual anal carcinoma (squamous cell carcinoma) following initial, usually definitive combination chemoradiotherapy.

APRs involves removal of the anus, the rectum and part of the sigmoid colon along with the associated (regional) lymph nodes, through incisions made in the abdomen and perineum. The end of the remaining sigmoid colon is brought out permanently as an opening, called a colostomy, on the surface of the abdomen.

Centralisation of rectal surgery

This operation is one of the less commonly performed by general surgeons, although they are specifically trained to perform this operation. As low case volumes in rectal surgery have been found to be associated with higher complication rates, [cite journal |author=Schrag D, Panageas KS, Riedel E, "et al" |title=Hospital and surgeon procedure volume as predictors of outcome following rectal cancer resection |journal=Ann. Surg. |volume=236 |issue=5 |pages=583–92 |year=2002 |month=November |pmid=12409664 |doi=10.1097/01.SLA.0000033036.14533.BC |url= |doi_brokendate=2008-06-22] [cite journal |author=Marusch F, Koch A, Schmidt U, Pross M, Gastinger I, Lippert H |title=Hospital caseload and the results achieved in patients with rectal cancer |journal=Br J Surg |volume=88 |issue=10 |pages=1397–402 |year=2001 |month=October |pmid=11578299 |doi=10.1046/j.0007-1323.2001.01873.x |url=] it is often centralised in larger centres, [cite journal |author=Martling A, Holm T, Cedermark B |title= [Skills by training. Education and case volume are strong prognostic factors in rectal cancer surgery] |language=Swedish |journal=Lakartidningen |volume=102 |issue=6 |pages=374–6 |year=2005 |pmid=15754678 |doi= |url=] where case volumes are higher.

Relation to anterior resection

An APR, generally, results in a worse quality of life than the less invasive lower anterior resection. [cite journal |author=McLeod RS |title=Comparison of quality of life in patients undergoing abdominoperineal extirpation or anterior resection for rectal cancer |journal=Ann. Surg. |volume=233 |issue=2 |pages=157–8 |year=2001 |pmid=11176119 |doi=10.1097/00000658-200102000-00002] [cite journal |author=Grumann MM, Noack EM, Hoffmann IA, Schlag PM |title=Comparison of quality of life in patients undergoing abdominoperineal extirpation or anterior resection for rectal cancer |journal=Ann. Surg. |volume=233 |issue=2 |pages=149–56 |year=2001 |pmid=11176118 |doi=10.1097/00000658-200102000-00001] Thus, LARs are generally the preferred treatment for rectal cancer insofar as this is surgically feasible.

APRs are the preferred operation for cancer in the distal one-third of the rectum. [American Cancer Society. Detailed Guide: Colon and Rectum Cancer. cancer.org. URL: [http://www.cancer.org/docroot/CRI/content/CRI_2_4_4x_Surgery_10.asp?sitearea= http://www.cancer.org/docroot/CRI/content/CRI_2_4_4x_Surgery_10.asp?sitearea=] . Accessed on: February 5, 2008.]

ee also

*Stoma (medicine)

References


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  • abdominoperineal — Relating to both abdomen and perineum, as in a. resection of the rectum. * * * ab·dom·i·no·per·i·ne·al .per ə nē əl adj relating to the abdominal and perineal regions …   Medical dictionary

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