Abdominoperineal resection

Abstract

Contemporary treatment of rectal cancer incorporates multiple modalities but surgery remains the cornerstone of any strategy. Careful operative technique is vital in achieving optimal outcomes particularly with respect to local recurrence. Following the adoption of total mesorectal excision for rectal cancer, it was noted that patients with rectal cancers undergoing abdominoperineal resection (APR) faired worse compared to those undergoing anterior resection when matched for stage. Subsequent developments in surgical technique sought to address this dilemma. This chapter describes the historical context of APR, contemporary APR and its rationale, open, laparoscopic and robotic resection techniques, documents outcomes and strategies for dealing wound closure following APR.