An abdominoperineal resection is a surgery in which usually sections of the anus, rectum and sigmoid colon are removed. This procedure generally used to treat cancers located very low in the rectum or in the anus region. Rectal cancer often requires more than one treatment type (modality), an approach known as multimodal therapy. In general, the treatment modalities used in rectal cancer are the same ones used to treat many other types of cancer. They are:
Surgery to remove the tumor.
- Chemotherapy, usually consisting of two or more drugs that target cancer cells. In people with rectal cancer, chemotherapy is often used along with radiation therapy, either before or after surgery. Radiation therapy, which uses high-powered beams, such as X-rays, to kill cancer cells.
Your surgical options depend on a number of factors, including The stage and grade of cancer, the location of the tumor in the rectum, the size of the tumor, your age, your general health, your medical history, your preferences after you learn about different procedures Some of the procedures commonly used to treat rectal cancer are:
- Abdominoperineal resection with end colostomy
Abdominoperineal resection (APR) offers the best chance of cure for rectal tumors located extremely close to the anal sphincter. With cancer in this location, the surgeon has to remove both the tumor and the sphincter.
- Coloanal anastomosis
This sphincter-sparing procedure may be an option for rectal cancer surgery if the tumor is at least .39 inch (1 centimeter) above the top of the anal sphincter.
- Low anterior resection
This procedure, which also leaves the anus intact, may be performed when the tumor is located in the upper part of the rectum.
- Local excision
Local excision takes out the rectal tumor, along with a margin of healthy tissue and the section of rectal wall beneath the tumor. This technique is generally reserved for early, small stage 1 rectal cancers, after a biopsy shows that the tumor is unlikely to spread or recur.
- More-extensive surgery
People with rectal cancer associated with Crohn’s disease, ulcerative colitis or a genetic predisposition to colorectal cancer typically need surgery that is more extensive than are the procedures described here. Chemotherapy is also needed before or after surgery.
A change in your bowel habits, such as diarrhea, constipation or more-frequent bowel movements
Dark or red blood in stool
Mucus in stool
Painful bowel movements
Iron deficiency anemia
A feeling that your bowel doesn't empty completely
Unexplained weight loss
Weakness or fatigue
Rectal cancer occurs when healthy cells in the rectum develop errors in their DNA. In most cases, the cause of these errors is unknown.
Healthy cells grow and divide in an orderly way to keep your body functioning normally. But when a cell's DNA is damaged and becomes cancerous, cells continue to divide even when new cells aren't needed. As the cells accumulate, they form a tumor.
With time, the cancer cells can grow to invade and destroy normal tissue nearby. And cancerous cells can travel to other parts of the body.
I am diabetic, can I undergo APR?
It is possible for a diabetic person to undergo APR safely if the diabetes is controlled and well managed. If the blood sugar level is high , it may lead to wound infection, delayed wound healing and gangrene.
How safe is APR?
Multi-institutional studies have shown that laparoscopic abdominoperineal resection can be performed safely and with reduced hospital stay. Because the specimen is removed through the perineum, no large abdominal incisions are required, which significantly reduces postoperative pain.
What care needs to be taken following APR?
You need to keep the incision clean and dry, take medications as directed by the physician, manage constipation by adopting healthy habits or taking medications if necessary, don’t do any strenuous activity or lift heavy objects etc.
What kind of foods can I have after APR?
– For the first few days after your surgery, you won’t be able to eat solid foods. You will follow a clear liquid diet. After that, you will slowly go back to eating solid foods.
Will I have a scar after APR has been performed?
– Depending upon the type of procedure undertaken, you can have 1 long scar or several small scars on the abdomen.
What is abdominoperineal resection and why is it done?
– An abdominoperineal resection is a surgery in which the anus, rectum, and sigmoid colon are removed. This procedure is most often used to treat cancers located very low in the rectum or in the anus.
What are the complications which may arise after APR?
– wound infection, Intraabdominal or pelvic pus formation, nerve injury, risk of postoperative sexual or urinary dysfunction etc.
How long does an APR surgery take?
– An APR procedure lasts for about 2 to 3 hours followed by hospitalization for around 10-15 days depending upon the recovery status of the person.