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Abdominoperineal Resection (APR)

Surgical removal of the anal canal and distal rectum together with the sphincter complex, with creation of a permanent colostomy.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Abdominoperineal Resection (APR)?

Abdominoperineal resection (APR) is the surgical procedure in which the rectum, anal canal, sphincter complex, and perianal skin are removed together and a permanent sigmoid colostomy is created. It was first described by Ernest Miles in 1908.

The operation is performed in two phases (abdominal and perineal). The abdominal phase includes mobilization of the sigmoid colon, mesorectal excision, and creation of the permanent colostomy; the perineal phase achieves en-bloc removal of the anus, distal rectum, and perianal tissue.

Indications include very low rectal cancer not amenable to sphincter-preserving surgery (anal verge <5 cm), tumors with sphincter invasion, anal canal cancer, patients with poor sphincter function, and rectal cancer unresponsive to neoadjuvant therapy. Extralevator APR (ELAPE) yields better oncologic outcomes.

Symptoms

Very low rectal cancer (<5 cm from anal verge)
Anal canal squamous-cell carcinoma (salvage surgery)
Rectal tumor with sphincter invasion
Preoperative fecal incontinence
Failure of sphincter-preserving surgery
T4 anal canal cancer
Melanoma and adenoid cystic carcinoma

Risk Factors

Perineal wound healing problems (after radiotherapy)
Quality-of-life impact of permanent colostomy
Presacral hemorrhage
Sexual dysfunction
Risk of genitourinary injury
Obesity and narrow pelvis
History of preoperative radiotherapy

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Diagnosis of very low rectal cancer
  • Anal canal malignancy
  • Anal pain and bleeding
  • Tenesmus and mucous discharge
  • Fecal incontinence with rectal cancer
  • Multidisciplinary tumor board referral

Treatment Methods

01
Preoperative pelvic MRI and CT
02
Neoadjuvant chemoradiotherapy
03
Abdominal phase: sigmoid mobilization, TME, colostomy
04
Perineal phase: removal of the sphincter complex
05
Preference for extralevator APR (ELAPE)
06
Primary closure or myocutaneous flap for the perineal defect
07
Stoma care education and long-term follow-up

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.