Cylindrical abdominoperineal resection for advanced low rectal cancer: a report of 15 cases / 中华普通外科杂志

ABSTRACT

Objective To decrease tumor local recurrence after abdominoperineal resection (APR)for low rectal cancer using cylindrical abdominoperineal resection. Methods From February 2009 to February 2010 cylindrical APR was performed in 15 patients of advanced ultralow rectal cancer at the Department of General Surgery, Qilu Hospital of Shandong University, according to the standard protocol as described by Holm. The procedure involves careful mobilization of the mesorectum as far down as the origins of the levator muscle. Ater stoma formation, the abdomen is closed, the patient is rotated into the prone position, and an extended perineal dissection is performed. This includes the sphincter complex and the inferior surface of the levators to a point laterally where they originate on the pelvic sidewall. This point should be just inferior to the level where the abdominal procedure was terminated. The coccyx is often removed in continuity with the main specimen to improve direct visualization of the dissection.Results The cylindrical technique removed more tissue in the distal rectum. There was no bowel perforation, perineal wounds were primary healing. One patient developed perineal seroma. One patient developed peritoneocele hernia of pelvic floor. Conclusions Cylindrical APR performed in the prone position for low rectal cancer removes more tissue around the tumor that leads to a reduction in intraoperative perforations, which should reduce local disease recurrence.