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Abdominoperineal Excision

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Rectal Cancer

Abstract

The story of abdominoperineal resection (APR) is one of surgical pioneers and innovators who not only developed revolutionary techniques to optimize outcomes but also contributed to our progressive understanding of rectal cancer biology. Prior to the introduction of surgical treatment, rectal cancer was a uniformly fatal disease. During the nineteenth and early twentieth centuries, extirpation of rectal tumors generally involved a perineal approach. In 1826, Jacques Lisfranc described a technique of blunt circumferential dissection through a perianal incision and subsequent amputation of the tumor-containing portion of the rectum. The transected rectum was allowed to retract and the wound packed for hemostasis and left open to drain [1]. Various modifications were adopted by Aristide Verneuil, Emil Kocher, and Paul Kraske using first coccygectomy and later sacrectomy to improve exposure and thus allow for more radical transperineal excisions [1–3]. Unfortunately, these approaches were associated with frequent incontinence, rectocutaneous fistulae, a mortality rate of approximately 20%, and a recurrence rate of 80% [1, 2].

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Authors and Affiliations

  1. Section of Colorectal Oncology, Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, 33612, USA

    Aaron U. Blackham & Julian Sanchez

  2. Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, 38117, USA

    David Shibata

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  1. Aaron U. Blackham
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Correspondence to David Shibata .

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  1. Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA

    George J. Chang

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Blackham, A.U., Sanchez, J., Shibata, D. (2018). Abdominoperineal Excision. In: Chang, G. (eds) Rectal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-16384-0_8

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