Outcomes for Abdominoperineal Resections Are Not Worse Than Those of Anterior Resections

Abstract

Both abdominoperineal resections and sphincter-preserving anterior resections can be performed safely with low morbidity and mortality in a specialized high-volume hospital unit without compromising oncologic outcomes. With appreciation of the anatomic relations in total mesorectal excision and standardized consistent surgical technique, the oncologic outcomes of patients treated by abdominoperineal resections are not worse than those treated by sphincter-preserving anterior resections.

Presentation and prognosis of local recurrence after total mesorectal excision

“…The overall survival at 2 years in our series was 85%, similar to that reported in the Dutch TME trial and others (Table 3) [12][13][14][16][17][18][19][20][21][22][23][24][25]. The LR rate at 2 years was 8%, slightly higher than in the Dutch trial [12] (5.3%), but in our series, only 32% of patients received preoperative radiotherapy.…”

Multicenter Study of Outcome in Relation to the Type of Resection in Rectal Cancer

“…another weakness of the study is the short period of follow-up. 10 although some institu-tions have observed equal outcomes after aPe and aR, 7,8 results from randomized trials show that lR and survival are worse after aPR than after aR. however, most of the recurrences in rectal cancer surgery are diagnosed in the first 3 to 5 postoperative years.…”

“…[1][2][3][4][5][6] however, others either do not report differences between operations [7][8][9] or showed no differences in the rates of local recurrence (lR) between both procedures. [1][2][3][4][5][6] however, others either do not report differences between operations [7][8][9] or showed no differences in the rates of local recurrence (lR) between both procedures.…”

Long-Term Survival and Recurrence Outcomes Following Surgery for Distal Rectal Cancer

“…For low-lying cancers at the pelvic floor and adjacent to the anal sphincters, the historically higher risk for positive circumferential resection margins and local failure following APR versus anterior resection may in part be due to inadequate resection at the level of the pelvic floor with TME, resulting in increased risk for a positive radial margin. 15,19–22 The TME plane brings the dissection margin very close to the lateral margin of the tumor where the need for wide resection is greatest. 23 We routinely perform a wide cylindrical resection of the levator ani in the region of the tumor during APR.…”