Journal of Gastrointestinal Surgery

, Volume 22, Issue 8, pp 1477–1487 | Cite as

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

  • 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
Evidence-Based Current Surgical Practice



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.


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.


Rectal cancer Total mesorectal excision Abdominoperineal resection Abdominoperineal excision Extralevator abdominoperineal excision APR APE ELAPE 



The authors would like to acknowledge Wali Johnson, M.D., for Fig. 3a–c. The authors would like to thank Anne Hawkins for her proofreading and editing.

Author Contribution

All authors have provided substantial contributions to the conception or design of the work or to the acquisition, analysis, or interpretation of the data for the work; drafted the work or revised it critically for important intellectual content; approved the version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Funding Information

This work was not funded.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Alexander T. Hawkins
    • 1
    • 2
  • Katherine Albutt
    • 1
  • Paul E. Wise
    • 3
  • Karim Alavi
    • 4
  • Ranjan Sudan
    • 5
  • Andreas M. Kaiser
    • 6
  • Liliana Bordeianou
    • 1
  • on behalf of the Continuing Education Committee of the SSAT
  1. 1.Department of Surgery, Section of Colon and Rectal SurgeryMassachusetts General HospitalBostonUSA
  2. 2.Division of General Surgery, Section of Colon and Rectal SurgeryVanderbilt UniversityNashvilleUSA
  3. 3.Section of Colon and Rectal SurgeryWashington University in St. LouisSt. LouisUSA
  4. 4.Department of SurgeryUMass Memorial Medical CenterWorcesterUSA
  5. 5.Department of SurgeryDuke University Medical CenterDurhamUSA
  6. 6.Department of Colorectal SurgeryUniversity of Southern CaliforniaLos AngelesUSA

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