Abstract:
BACKGROUND:For patients with rectal cancer, there is a greater risk of a positive radial margin or local tumor recurrence when an abdominoperineal versus low anterior resection is performed, or when tumors are in an anterior versus nonanterior location. In response, clinical leaders have encouraged perineal dissection in the prone position or in concert with a coccygectomy. We describe anterior-entry abdominoperineal resection, which may minimize the need for such maneuvers and negative patient outcomes. METHODS:Anterior-entry abdominoperineal resection was provided by one surgeon to 10 patients over an 18-month period. Pelvic dissection used total mesorectal excision techniques. Anteriorly, in men, the perineal dissection occurred between the external anal sphincter and the bulbospongiosus and transversus perinei superficialis muscles. Initial entry into the pelvis occurred anteriorly under direct vision. Rectal specimen quality was graded out of 5 using Quirke methods. RESULTS:There were 8 male and 2 female subjects with a median age of 65 years. Eight of 10 tumors had some component of an anterior location. Seven patients received preoperative radiation. The radial margin was positive in 1 case. Median Quirke score for quality of the surgical specimen was 5 of 5. CONCLUSIONS:Anterior-entry abdominoperineal resection follows anatomic planes in the perineum and demands initial entry into the pelvis anteriorly and under direct vision. It may minimize rates of positive radial margins, may be especially suited for tumors with a locally advanced anterior component, and in many patients may avoid the need for perineal dissection in the jackknife position.
journal_name
Ann Surg Oncoljournal_title
Annals of surgical oncologyauthors
Simunovic M,Pinthus J,Coates AJ,DeNardi Fdoi
10.1245/s10434-011-2016-5subject
Has Abstractpub_date
2012-03-01 00:00:00pages
794-800issue
3eissn
1068-9265issn
1534-4681journal_volume
19pub_type
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journal_title:Annals of surgical oncology
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abstract:: ...
journal_title:Annals of surgical oncology
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