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Erschienen in: Journal of Gastrointestinal Surgery 8/2018

16.04.2018 | Evidence-Based Current Surgical Practice

Abdominoperineal Resection for Rectal Cancer in the Twenty-First Century: Indications, Techniques, and Outcomes

verfasst von: Alexander T. Hawkins, Katherine Albutt, Paul E. Wise, Karim Alavi, Ranjan Sudan, Andreas M. Kaiser, Liliana Bordeianou, on behalf of the Continuing Education Committee of the SSAT

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 8/2018

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Abstract

Background

Management of low rectal cancer continues to be a challenge, and decision making regarding the need for an abdominoperineal resection (APR) in patients with low-lying tumors is complicated. Furthermore, choices need to be made regarding need for modification of the surgical approach based on tumor anatomy and patient goals.

Discussion

In this article, we address patient selection, preoperative planning, and intraoperative technique required to perform the three types of abdominoperineal resections for rectal cancer: extrasphincteric, extralevator, and intersphincteric. Attention is paid not only to traditional oncologic outcomes such as recurrence and survival but also to patient-reported outcomes and quality of life.
Literatur
1.
Zurück zum Zitat Graney MJ, Graney CM. Colorectal surgery from antiguity to the modern era. Dis Colon Rectum. 1980;23(6):432–41.CrossRefPubMed Graney MJ, Graney CM. Colorectal surgery from antiguity to the modern era. Dis Colon Rectum. 1980;23(6):432–41.CrossRefPubMed
2.
Zurück zum Zitat WE M. The radical abdomino-perineal operation for cancer of the pelvic colon. BMJ. 1910;11:941–3. WE M. The radical abdomino-perineal operation for cancer of the pelvic colon. BMJ. 1910;11:941–3.
3.
Zurück zum Zitat Miles WE. The Present Position of the Radical Abdomino-Perineal Operation for Cancer of the Rectum in Regard to Mortality and Post-operative Recurrence. Proc R Soc Med. 1931;24(7):989–91.PubMedPubMedCentral Miles WE. The Present Position of the Radical Abdomino-Perineal Operation for Cancer of the Rectum in Regard to Mortality and Post-operative Recurrence. Proc R Soc Med. 1931;24(7):989–91.PubMedPubMedCentral
5.
Zurück zum Zitat MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet (London, England). 1993;341(8843):457–60.CrossRef MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet (London, England). 1993;341(8843):457–60.CrossRef
6.
Zurück zum Zitat Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision.Lancet (London, England). 1986;2(8514):996–9.CrossRef Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision.Lancet (London, England). 1986;2(8514):996–9.CrossRef
8.
Zurück zum Zitat Bordeianou L, Maguire LH, Alavi K, Sudan R, Wise PE, Kaiser AM. Sphincter-sparing surgery in patients with low-lying rectal cancer: techniques, oncologic outcomes, and functional results. Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract. 2014;18(7):1358–72. doi:https://doi.org/10.1007/s11605-014-2528-y. CrossRef Bordeianou L, Maguire LH, Alavi K, Sudan R, Wise PE, Kaiser AM. Sphincter-sparing surgery in patients with low-lying rectal cancer: techniques, oncologic outcomes, and functional results. Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract. 2014;18(7):1358–72. doi:https://​doi.​org/​10.​1007/​s11605-014-2528-y.​ CrossRef
14.
Zurück zum Zitat Benson AB, 3rd, Venook AP, Bekaii-Saab T, Chan E, Chen YJ, Cooper HS et al. Rectal Cancer, Version 2.2015. J Natl Compr Canc Netw. 2015;13(6):719–28; quiz 28.CrossRefPubMed Benson AB, 3rd, Venook AP, Bekaii-Saab T, Chan E, Chen YJ, Cooper HS et al. Rectal Cancer, Version 2.2015. J Natl Compr Canc Netw. 2015;13(6):719–28; quiz 28.CrossRefPubMed
21.
Zurück zum Zitat Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M et al. Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes The ACOSOG Z6051 Randomized Clinical Trial. JAMA-J Am Med Assoc. 2015;314(13):1346–55. doi:https://doi.org/10.1001/jama.2015.10529. CrossRef Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M et al. Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes The ACOSOG Z6051 Randomized Clinical Trial. JAMA-J Am Med Assoc. 2015;314(13):1346–55. doi:https://​doi.​org/​10.​1001/​jama.​2015.​10529.​ CrossRef
23.
Zurück zum Zitat Kang CY, Carmichael JC, Friesen J, Stamos MJ, Mills S, Pigazzi A. Robotic-assisted extralevator abdominoperineal resection in the lithotomy position: technique and early outcomes. Am Surg. 2012;78(10):1033–7.PubMed Kang CY, Carmichael JC, Friesen J, Stamos MJ, Mills S, Pigazzi A. Robotic-assisted extralevator abdominoperineal resection in the lithotomy position: technique and early outcomes. Am Surg. 2012;78(10):1033–7.PubMed
26.
Zurück zum Zitat Collinson FJ, Jayne DG, Pigazzi A, Tsang C, Barrie JM, Edlin R et al. An international, multicentre, prospective, randomised, controlled, unblinded, parallel-group trial of robotic-assisted versus standard laparoscopic surgery for the curative treatment of rectal cancer. Int J Colorectal Dis. 2012;27(2):233–41. doi:https://doi.org/10.1007/s00384-011-1313-6.CrossRefPubMed Collinson FJ, Jayne DG, Pigazzi A, Tsang C, Barrie JM, Edlin R et al. An international, multicentre, prospective, randomised, controlled, unblinded, parallel-group trial of robotic-assisted versus standard laparoscopic surgery for the curative treatment of rectal cancer. Int J Colorectal Dis. 2012;27(2):233–41. doi:https://​doi.​org/​10.​1007/​s00384-011-1313-6.CrossRefPubMed
27.
Zurück zum Zitat Pigazzi A. Results of robotic vs Laparoscopic Resection for Rectal Cancer: ROLARR study [Abstract]. In press 2015. Pigazzi A. Results of robotic vs Laparoscopic Resection for Rectal Cancer: ROLARR study [Abstract]. In press 2015.
34.
Zurück zum Zitat Smith RL, Bohl JK, McElearney ST, Friel CM, Barclay MM, Sawyer RG et al. Wound infection after elective colorectal resection. Ann Surg. 2004;239(5):599–605; discussion -7.CrossRefPubMedPubMedCentral Smith RL, Bohl JK, McElearney ST, Friel CM, Barclay MM, Sawyer RG et al. Wound infection after elective colorectal resection. Ann Surg. 2004;239(5):599–605; discussion -7.CrossRefPubMedPubMedCentral
35.
Zurück zum Zitat Goto S, Hasegawa S, Hata H, Yamaguchi T, Hida K, Nishitai R et al. Differences in surgical site infection between laparoscopic colon and rectal surgeries: sub-analysis of a multicenter randomized controlled trial (Japan-Multinational Trial Organization PREV 07-01). Int J Colorectal Dis. 2016;31(11):1775–84. doi:https://doi.org/10.1007/s00384-016-2643-1.CrossRefPubMed Goto S, Hasegawa S, Hata H, Yamaguchi T, Hida K, Nishitai R et al. Differences in surgical site infection between laparoscopic colon and rectal surgeries: sub-analysis of a multicenter randomized controlled trial (Japan-Multinational Trial Organization PREV 07-01). Int J Colorectal Dis. 2016;31(11):1775–84. doi:https://​doi.​org/​10.​1007/​s00384-016-2643-1.CrossRefPubMed
36.
Zurück zum Zitat Robles Campos R, Garcia Ayllon J, Parrila Paricio P, Cifuentes Tebar J, Lujan Mompean JA, Liron Ruiz R et al. Management of the perineal wound following abdominoperineal resection: prospective study of three methods. Br J Surg. 1992;79(1):29–31.CrossRefPubMed Robles Campos R, Garcia Ayllon J, Parrila Paricio P, Cifuentes Tebar J, Lujan Mompean JA, Liron Ruiz R et al. Management of the perineal wound following abdominoperineal resection: prospective study of three methods. Br J Surg. 1992;79(1):29–31.CrossRefPubMed
37.
Zurück zum Zitat Christian CK, Kwaan MR, Betensky RA, Breen EM, Zinner MJ, Bleday R. Risk factors for perineal wound complications following abdominoperineal resection. Dis Colon Rectum. 2005;48(1):43–8.CrossRefPubMed Christian CK, Kwaan MR, Betensky RA, Breen EM, Zinner MJ, Bleday R. Risk factors for perineal wound complications following abdominoperineal resection. Dis Colon Rectum. 2005;48(1):43–8.CrossRefPubMed
39.
Zurück zum Zitat Wolmark N, Fisher B. An analysis of survival and treatment failure following abdominoperineal and sphincter-saving resection in Dukes’ B and C rectal carcinoma. A report of the NSABP clinical trials. National Surgical Adjuvant Breast and Bowel Project. Ann Surg. 1986;204(4):480–9.CrossRefPubMedPubMedCentral Wolmark N, Fisher B. An analysis of survival and treatment failure following abdominoperineal and sphincter-saving resection in Dukes’ B and C rectal carcinoma. A report of the NSABP clinical trials. National Surgical Adjuvant Breast and Bowel Project. Ann Surg. 1986;204(4):480–9.CrossRefPubMedPubMedCentral
40.
Zurück zum Zitat den Dulk M, Putter H, Collette L, Marijnen CA, Folkesson J, Bosset JF et al. The abdominoperineal resection itself is associated with an adverse outcome: the European experience based on a pooled analysis of five European randomised clinical trials on rectal cancer. Eur J Cancer. 2009;45(7):1175–83. doi:https://doi.org/10.1016/j.ejca.2008.11.039.CrossRef den Dulk M, Putter H, Collette L, Marijnen CA, Folkesson J, Bosset JF et al. The abdominoperineal resection itself is associated with an adverse outcome: the European experience based on a pooled analysis of five European randomised clinical trials on rectal cancer. Eur J Cancer. 2009;45(7):1175–83. doi:https://​doi.​org/​10.​1016/​j.​ejca.​2008.​11.​039.CrossRef
42.
Zurück zum Zitat Marr R, Birbeck K, Garvican J, Macklin CP, Tiffin NJ, Parsons WJ et al. The modern abdominoperineal excision: the next challenge after total mesorectal excision. Ann Surg. 2005; 242(1):74–82.CrossRefPubMedPubMedCentral Marr R, Birbeck K, Garvican J, Macklin CP, Tiffin NJ, Parsons WJ et al. The modern abdominoperineal excision: the next challenge after total mesorectal excision. Ann Surg. 2005; 242(1):74–82.CrossRefPubMedPubMedCentral
52.
54.
Zurück zum Zitat Bauer JJ, Gelernt IM, Salk BA, Kreel I. Proctectomy for inflammatory bowel disease. American Journal of Surgery. 1986;151(1):157–62.CrossRefPubMed Bauer JJ, Gelernt IM, Salk BA, Kreel I. Proctectomy for inflammatory bowel disease. American Journal of Surgery. 1986;151(1):157–62.CrossRefPubMed
Metadaten
Titel
Abdominoperineal Resection for Rectal Cancer in the Twenty-First Century: Indications, Techniques, and Outcomes
verfasst von
Alexander T. Hawkins
Katherine Albutt
Paul E. Wise
Karim Alavi
Ranjan Sudan
Andreas M. Kaiser
Liliana Bordeianou
on behalf of the Continuing Education Committee of the SSAT
Publikationsdatum
16.04.2018
Verlag
Springer US
Erschienen in
Journal of Gastrointestinal Surgery / Ausgabe 8/2018
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-018-3750-9

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