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Abdominoperineal Excision With Partial AnteriorEn BlocResection in Multimodal Management of Low Rectal Cancer: A Strategy to Reduce Local Recurrence

Smedh Kennet M.D. Ph.D. F.R.C.S.; Khani, Maziar Hosseinali M.D.; Kraaz, Wolfgang M.D., Ph.D.; Raab, Yngve M.D., Ph.D.; Strand, Eva Specialist Nurse
Diseases of the Colon & Rectum: June 2006
doi: 10.1007/s10350-006-0539-9
Abdominoperineal Excision With Partial Anterior En Bloc Resection in Multimodal Management of Low Rectal Cancer: A Strategy to Reduce Local Recurrence: PDF Only

Purpose: Purpose:Total mesorectal excision is the gold standard inthe performance of an abdominoperineal resection but little has changed in the way the perineal operation is performed. A frequent problem is anterior dissection. The aim of this study was to present the results of abdominoperineal resection using selected partial anterioren blocresection to reduce recurrence.

Methods: Methods:The data were population-based and prospectively registered. Two experienced surgeons performed the operations. In selected cases, depending on clinical and magnetic resonance imaging findings, parts of the vagina or prostate close to the tumor were resected. All specimens were examined according to Quirke.

Results: Results:Sixty-three patients underwent abdominoperineal resection with total mesorectal excision; 56 received preoperative radiotherapy. The tumors involved the anterior bowel wall in 40 cases and in 23 (58 percent) of them,en blocresections were performed. The distance from the tumor to the conventional resection margin (withouten blocresection) was 0 mm in ten cases. The median follow-up period was 37 months. So far, one (1.7 percent) local recurrence has been detected in 58 (92 percent) curative and indeterminate cases. The cancer-specific five-year survival in these cases was 87 percent (Kaplan-Meier).

Conclusion: Conclusion:A multimodal management regimen in patients with low rectal cancer, including preoperative radiotherapy and abdominoperineal resection with a high frequency of partialen blocresection of the vagina or prostate, resulted in excellent local control and survival. In some male patients, excenteration with urinary stoma can be avoided.

Presented at the meeting of the European Association of ColoProctology (EACP), Geneva, Switzerland, September 16 to 18, 2004.

Supported by a research grant from the County of Västmanland, Sweden.

Reprints are not available.


© The ASCRS 2006