A Comprehensive Guide to Abdominoperineal Resection Treatment

Abdominoperineal resection (APR) is a type of surgery in which the anus, rectum, and sigmoid colon are removed through small cuts in the belly. It is a surgical procedure done primarily to remove the cancer of the rectum. Typically, abdominoperineal resection (AP) is conducted as an elective procedure. This procedure is most often used to treat rectum cancer if it is located very low in the rectum or the anus, close to the sphincter muscles.

Nowadays, advanced surgical techniques and other treatment modalities have brought an increase in the rate of sphincter-sparing operations. However, APR surgery is still necessary in selected cases, especially if the patient has distal tumors or poor sphincter function. AP resection is a major operation. During perineal resection, the rectum, distal colon, and anal sphincter complex are completely removed using both anterior abdominal and perineal incisions. Once the anus and rectum are removed, a permanent colostomy is needed to complete the procedure.

Colostomy brings the colon to an opening at the surface of the skin, which allows the waste to pass out of the body. This new opening is called stoma and usually measures from one to one-and-a-half inches in diameter. A pouch, or a stoma appliance, is needed to be worn at all times. The stoma has no sphincter muscles, so there is no conscious control over the elimination of waste products from the body after the procedure.

Following are some signs and symptoms that may indicate the need for an APR:

Rectal Bleeding: This is one of the most common symptoms of rectal or anal cancer. Blood in the stool or bleeding during bowel movements may occur.
Change in Bowel Habits: Persistent changes in bowel habits such as diarrhea, constipation, or changes in stool consistency that last more than a few days may indicate a problem.
Rectal Pain or Discomfort: Pain or discomfort in the rectum or anus, particularly during bowel movements, can be a symptom of rectal or anal cancer.
Incomplete Evacuation: Difficulty emptying the bowels or feeling like there's still stool left after a bowel movement a sign of obstruction.
Pelvic Pain: Some individuals may experience pelvic pain or pressure, which can be caused by the presence of a tumor in the rectum or anus.
Visible Mass or Lump: In some cases, a visible mass or lump may be felt near the anus or in the lower rectum.
Weight Loss: Unexplained weight loss may occur in individuals with advanced rectal or anal cancer.

Before performing an abdominoperineal resection (APR), some diagnostic tests are conducted to evaluate the extent of the disease and to ensure that surgery is appropriate. These tests help in staging the cancer, assessing its location and spread, and determining the overall health of the patient. Common diagnostic tests include:

Digital Rectal Examination (DRE): A physical examination is done in which the doctor inserts a gloved, lubricated finger into the rectum to feel for any abnormalities, such as lumps or masses.

Colonoscopy: This is performed by a flexible tube with a camera (colonoscope) inserted into the rectum and guided through the colon to examine the entire length of the large intestine.

Computed Tomography (CT) Scan: A CT helps detect the tumor's size and location, as well as any spread to nearby lymph nodes or other organs.

Positron Emission Tomography (PET) Scan: It helps detect metastases (spread) to distant organs or lymph nodes.

Biopsy: It is used to confirm the presence of cancer and determine the type and grade.

The patient's recovery depends on individual circumstances and general health. A patient may be required to stay in the hospital for three to seven days. However, some patients may need more time to recover.

The patient can walk and stand on the first day after AP resection and resume most of the usual activities shortly after the surgery. Increased activity reduces the chances of blood clotting and also improves breathing.

Proper wound care is essential to prevent infections, and patients receive guidance on caring for surgical incisions and drainage tubes. Nutritionists provide dietary advice to support healing, while physical therapists guide patients in gentle exercises to improve strength and mobility. Healthcare teams also offer emotional support to help patients cope with recovery's physical and emotional challenges.