Abdominoperineal resection
Encyclopedia
An abdomino
perineal
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 or anal cancer
. It is frequently abbreviated
as AP resection and APR.
) 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.
than the less invasive lower anterior resection
(LAR). Thus, LARs are generally the preferred treatment for rectal cancer insofar as this is surgically feasible.
Abdomen
In vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...
perineal
Perineal
Perineal can refer to:* The perineum* Perineal artery* Perineal nerve...
resection
Segmental resection
Segmental resection is a surgical procedure to remove part of an organ or gland. It may also be used to remove a tumor and normal tissue around it. In lung cancer surgery, segmental resection refers to removing a section of a lobe of the lung.- External links :* entry in the public domain NCI...
, formally known as abdominoperineal resection of the rectum and abdominoperineal excision of the rectum
Rectum
The rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...
or simply abdominoperineal excision, is a surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
for rectal cancer or anal cancer
Anal cancer
Anal cancer is a type of cancer which arises from the anus, the distal orifice of the gastrointestinal tract. It is a distinct entity from the more common colorectal cancer. The etiology, risk factors, clinical progression, staging, and treatment are all different. Anal cancer is typically a...
. It is frequently abbreviated
Abbreviation
An abbreviation is a shortened form of a word or phrase. Usually, but not always, it consists of a letter or group of letters taken from the word or phrase...
as AP resection and APR.
Indication and description
The principal indication for AP resection is a rectal carcinoma situated in the distal (lower) one-third of the rectum. Other indications include recurrent or residual anal carcinoma (squamous cell carcinomaSquamous cell carcinoma
Squamous cell carcinoma , occasionally rendered as "squamous-cell carcinoma", is a histologically distinct form of cancer. It arises from the uncontrolled multiplication of malignant cells deriving from epithelium, or showing particular cytological or tissue architectural characteristics of...
) following initial, usually definitive combination chemoradiotherapy.
APRs involves removal of the anus
Anus
The anus is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, unwanted semi-solid matter produced during digestion, which, depending on the type of animal, may be one or more of: matter which the animal cannot digest,...
, the rectum
Rectum
The rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...
and part of the sigmoid colon
Sigmoid colon
The sigmoid colon is the part of the large intestine that is closest to the rectum and anus. It forms a loop that averages about 40 cm...
along with the associated (regional) lymph nodes, through incisions made in the abdomen
Abdomen
In vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...
and perineum
Perineum
In human anatomy, the perineum is a region of the body including the perineal body and surrounding structures...
. The end of the remaining sigmoid colon
Sigmoid colon
The sigmoid colon is the part of the large intestine that is closest to the rectum and anus. It forms a loop that averages about 40 cm...
is brought out permanently as an opening, called a colostomy
Colostomy
A colostomy is a surgical procedure in which a stoma is formed by drawing the healthy end of the large intestine or colon through an incision in the anterior abdominal wall and suturing it into place. This opening, in conjunction with the attached stoma appliance, provides an alternative channel...
, 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, it is often centralised in larger centres, where case volumes are higher.Relation to low anterior resection (LAR)
An APR, generally, results in a worse quality of lifeQuality of life
The term quality of life is used to evaluate the general well-being of individuals and societies. The term is used in a wide range of contexts, including the fields of international development, healthcare, and politics. Quality of life should not be confused with the concept of standard of...
than the less invasive lower anterior resection
Lower anterior resection
A lower anterior resection, formally known as anterior resection of the rectum and anterior excision of the rectum or simply anterior resection , is a common surgery for rectal cancer and occasionally is performed to remove a diseased or ruptured portion of the intestine in cases of diverticulitis...
(LAR). Thus, LARs are generally the preferred treatment for rectal cancer insofar as this is surgically feasible.
External links
- Laparoscopic Abdominoperineal Resection: Basic Surgical Steps - Cleveland ClinicCleveland ClinicThe Cleveland Clinic is a multispecialty academic medical center located in Cleveland, Ohio, United States. The Cleveland Clinic is currently regarded as one of the top 4 hospitals in the United States as rated by U.S. News & World Report...
- APR Surgery Videos