Abdominoperineal Resection

Abdominoperineal resection (APR) is a surgical procedure that involves the removal of the rectum and anus, resulting in the creation of a permanent end colostomy. This procedure is typically carried out for low rectal cancers where it is not possible to spare the sphincters during curative resection, as well as for anal cancers that do not respond to chemoradiation or recur. In some cases, benign conditions such as perianal Crohn disease, complex anorectal fistulae, and severe trauma may also necessitate an APR.

During an APR, the rectum, surrounding mesorectum, anal sphincter complex, and anus are removed, and the perineal opening is closed (see Image. Abdominoperineal Resection Specimen). The distal colon is then brought out as a permanent end colostomy. The extent of the operation and resection of surrounding structures depends on the specific pathology, patient factors, and the stage of the disease. Due to advancements in diagnostic techniques, radiation, and chemotherapeutic improvements, APRs are becoming less common in favor of more sphincter-sparing approaches. While this procedure was traditionally performed with a laparotomy and a separate perineal incision, it is now commonly carried out using laparoscopy or robotic surgery. APR is associated with significant morbidity. In addition, patients undergoing an APR have a permanent colostomy and may experience a considerable rate of genitourinary and sexual dysfunction that can affect their quality of life. Therefore, appropriate counseling, psychosocial support, good surgical technique, and perioperative care are essential for positive patient outcomes.