Laparoscopic Abdominoperineal Resection
The description of the abdominoperineal resection (APR) of rectal tumors by W. Ernest Miles1 in 1908 is a landmark in the history of colorectal surgery. The complete excision of the rectum and sigmoid colon improved longterm survival of patients with rectal cancer because it removed the proximal extent of lymphatic spread of the tumor. Even though the mortality of the procedure was initially high, the perceived benefits were significant and justified its continued use. The need for an APR in patients with a rectal cancer is now limited only to those patients with deeply invasive advanced tumor involving the anal sphincter mechanism. This anatomic fact prevents the restorative low anterior resection of the rectum, which is now so commonly performed for all but the most distal, low rectal cancers, using stapling techniques. Since 1908, three major changes in the operative technique have emerged: stapled low colorectal anastomosis, mesorectal excision, and, most recently, laparoscopy. As mentioned above, stapling procedures have reduced the need for APR below 5% of patients with rectal cancer.
KeywordsRectal Cancer Total Mesorectal Excision Laparoscopic Resection Laparoscopic Colectomy Radial Margin
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