Abdominoperineal Resection

Introduction

Abdominoperineal resection (APR) is most often employed for lower-third rectal cancers, rare low pelvic tumors, and other low pelvic cancers requiring pelvic exenteration with involvement of the sphincters. Tumors above the levator muscles and inflammatory bowel diseases (IBD) can typically be treated with sphincter-sparing restorative and nonrestorative intersphincteric proctectomy. Patients with anal squamous cell carcinoma with persistent or recurrent disease despite, or who have contraindication to, definitive chemoradiation with Nigro protocol, are also candidates for APR. Occasionally, patients with severe fistulizing perianal Crohn’s disease require an APR, often with myocutaneous flap reconstruction. This chapter describes a standardized approach to resection of the rectum and anal sphincter complex.