Clin Colon Rectal Surg 2017; 30(05): 357-367
DOI: 10.1055/s-0037-1606113
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Abdominoperineal Excision: Technical Challenges in Optimal Surgical and Oncological Outcomes after Abdominoperineal Excision for Rectal Cancer

Torbjörn Holm
1   Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
› Author Affiliations
Further Information

Publication History

Publication Date:
27 November 2017 (online)

Abstract

Treatment results in rectal cancer have improved significantly during the recent two decades, but local control and survival after abdominoperineal excision (APE) have not improved to the same degree as that seen after anterior resection (AR). The reason for this is an increased risk of inadvertent bowel perforations and tumor involved margins after APE as compared with AR. The conventional synchronous combined APE has not been a standardized procedure and consequently oncological outcomes have varied considerably between different institutions and in different reports. With the new concept of APE, based on well-defined anatomical structures, the procedure can be categorized as intersphincteric APE, extralevator APE, and ischioanal APE. This article discusses the technical aspects and results from this approach.

 
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