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Surgery for Cancers of the Gastrointestinal Tract pp 263–274Cite as

Open Abdominoperineal Resection

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Abstract

Low-lying cancers of the rectum and anal canal may require abdominoperineal resection (APR) to clear disease. Although APR may be performed with the patient in supine or prone position, we favor the supine lithotomy approach. Since this procedure may be associated with significant morbidity, preoperative screening and patient selection are important. In this chapter, we review the step-by-step procedure to perform open lithotomy APR.

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Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Peking University Cancer Hospital, Beijing, People’s Republic of China

    Lin Wang M.D. & Jin Gu M.D., F.A.C.S.

  2. Division of Colon & Rectal Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Philip Paty M.D.

Authors
  1. Lin Wang M.D.
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  2. Jin Gu M.D., F.A.C.S.
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  3. Philip Paty M.D.
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Corresponding author

Correspondence to Philip Paty M.D. .

Editor information

Editors and Affiliations

  1. Division of Surgical Oncology, City of Hope, Los Angeles, California, USA

    Joseph Kim

  2. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    Julio Garcia-Aguilar

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

In this video, the surgeon demonstrates his approach to open lithotomy abdominoperineal resection. (MP4 823439 kb)

Key Operative Steps

  1. 1.

    The patient is placed in lithotomy position.

  2. 2.

    The abdomen is opened and explored to rule out metastatic disease.

  3. 3.

    The sigmoid colon is mobilized and the left ureter and gonadal vessels are identified and preserved.

  4. 4.

    Incise the right lateral peritoneum from the sacral promontory to the origin of the IMA.

  5. 5.

    Perform low ligation of the IMA including the superior rectal vessels and the first trunk of sigmoid vessels.

  6. 6.

    Divide the sigmoid colon with a linear stapler ensuring adequate mobilization for tension-free, well-vascularized colostomy.

  7. 7.

    Retract sigmoid and rectum anteriorly for posterior dissection and proceed with anterior and lateral dissection.

  8. 8.

    Establish plane of extralevator resection and complete levator dissection.

  9. 9.

    Begin perineal phase with an elliptical incision around the anus.

  10. 10.

    The incision is carried anteriorly to the perineal body and laterally and posteriorly through the ischiorectal fossa until the anococcygeal ligament and the posterior/lateral levator muscles are exposed.

  11. 11.

    Proceed with dissection circumferentially around the rectum until it is completely free.

  12. 12.

    Remove the specimen transanally and close the perineal defect. Drain the pelvis and perineal space.

  13. 13.

    Create and mature an end colostomy.

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Wang, L., Gu, J., Paty, P. (2015). Open Abdominoperineal Resection. In: Kim, J., Garcia-Aguilar, J. (eds) Surgery for Cancers of the Gastrointestinal Tract. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1893-5_24

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  • DOI: https://doi.org/10.1007/978-1-4939-1893-5_24

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1892-8

  • Online ISBN: 978-1-4939-1893-5

  • eBook Packages: MedicineMedicine (R0)

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