Abdominoperineal Excision of the Rectum

With the development of total mesorectal excision (TME) as the gold standard procedure in rectal cancer, leading to substantially improved results after low anterior resection (LAR), many surgeons advocated low or ultralow anterior resection for tumours of the lower rectum. It has been shown that these procedures are feasible and oncologically safe if the tumour can be removed with clear distal and circumferential margins [1]. Total mesorectal excision (TME) and restorative resections with an anastomosis is feasible in many patients with rectal cancer. However, patients with poor anal function and very low advanced tumours are not suitable for restorative procedures. Abdomino-perineal resections may be preferable in such situations. This chapter describes the indications and technical details for different types of abdomino-perineal resections.