An abdomino perineal resection, formally known as abdominoperineal resection of the rectum and abdominoperineal excision of the

rectum The rectum is the final straight portion of the large intestine in humans and some other mammals, and the Gastrointestinal tract, gut in others. The adult human rectum is about long, and begins at the rectosigmoid junction (the end of the s ...

is a

surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

for

rectal cancer Colorectal cancer (CRC), also known as bowel cancer, colon cancer, or rectal cancer, is the development of cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of th ...

anal cancer Anal cancer is a cancer which arises from the anus, the distal opening of the gastrointestinal tract. Symptoms may include bleeding from the anus or a lump near the anus. Other symptoms may include pain, itchiness, or discharge from the anus. ...

. It is frequently

abbreviated An abbreviation (from Latin ''brevis'', meaning ''short'') is a shortened form of a word or phrase, by any method. It may consist of a group of letters or words taken from the full version of the word or phrase; for example, the word ''abbrevia ...

as AP resection, APR and APER.

Indication and description

See image on National Cancer Institute website
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 carcinoma Squamous-cell carcinomas (SCCs), also known as epidermoid carcinomas, comprise a number of different types of cancer that begin in squamous cells. These cells form on the surface of the skin, on the lining of hollow organs in the body, and on the ...

) following initial, usually definitive combination chemoradiotherapy. APRs involves removal of the

anus The anus (Latin, 'ring' or 'circle') 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, the residual semi-solid waste that remains after food digestion, which, d ...

, the

and part of the

sigmoid colon The sigmoid colon (or pelvic colon) is the part of the large intestine that is closest to the rectum and anus. It forms a loop that averages about in length. The loop is typically shaped like a Greek letter sigma (ς) or Latin letter S (thus ''s ...

along with the associated (regional)

lymph nodes A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that includ ...

, through incisions made in the

abdomen The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the torso. ...

and

perineum The perineum in humans is the space between the anus and scrotum in the male, or between the anus and the vulva in the female. The perineum is the region of the body between the pubic symphysis (pubic arch) and the coccyx (tail bone), includi ...

. The end of the remaining

is brought out permanently as an opening, called a

stoma In botany, a stoma (from Greek ''στόμα'', "mouth", plural "stomata"), also called a stomate (plural "stomates"), is a pore found in the epidermis of leaves, stems, and other organs, that controls the rate of gas exchange. The pore is bor ...

, which is used by the patient in conjunction with a

colostomy A colostomy is an opening ( stoma) in the large intestine (colon), or the surgical procedure that creates one. The opening is formed by drawing the healthy end of the colon through an incision in the anterior abdominal wall and suturing it int ...

pouch, on the surface of the abdomen.

Centralisation of rectal surgery

This operation is one of the less commonly performed by

general surgeon General surgery is a surgical specialty that focuses on alimentary canal and abdominal contents including the esophagus, stomach, small intestine, large intestine, liver, pancreas, gallbladder, appendix and bile ducts, and often the thyroid ...

s, 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.

Laparoscopic approach

There are several advantages in terms of outcomes if the surgery can be performed laparoscopically

Relation to low anterior resection (LAR)

An APR, generally, results in a worse

quality of life Quality of life (QOL) is defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards ...

than the less invasive lower anterior resection (LAR). Thus, LARs are generally the preferred treatment for rectal cancer insofar as this is surgically feasible.

Eponym

It is named for

William Ernest Miles William Ernest Miles (15 January 1869 – 24 September 1947) was an English surgeon known for the Miles' operation: an abdomino-perineal excision for rectal cancer. Sources differ as to whether Miles was born in Trinidad or in Uppingham, Englan ...

(1869–1947), an English surgeon who published his technique in a landmark paper in 1908.

References

External links

Laparoscopic Abdominoperineal Resection: Basic Surgical Steps
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Cleveland Clinic Cleveland Clinic is a nonprofit American academic medical center based in Cleveland, Ohio. Owned and operated by the Cleveland Clinic Foundation, an Ohio nonprofit corporation established in 1921, it runs a 170-acre (69 ha) campus in Cleveland, ...

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