Extended Abdominoperineal Resection

Several retrospective case series have shown that in patients with colorectal cancer fixed to adjacent organs, en block resection of the primary tumor and the surrounding organs resulted in lower recurrence and better survival compared to separating the tumor from the adjacent organ. These differences in long-term survival between patients undergoing multivisceral versus standard resection were significant despite the higher surgical mortality associated with multivisceral resection. Based on these early reports, radical en block resection of the primary tumor and surrounding organs has become the standard operation for locally advanced colorectal cancer adherent to adjacent structures. Treatment often requires a multidisciplinary surgical and medical team that in addition to the colorectal surgeon should include a medical oncologist, a radiation oncologist, and urologist, and often a plastic surgeon. Advances in the imaging studies that made it possible to identify patients with locally advanced disease preoperatively, to select the patients who are candidates for curative surgery, and to plan the extent of the resection. Many of these patients may be candidates to preoperative adjuvant therapy. Organs adherent to the tumor at the time of the surgery should be removed in continuity with the rectum. Every effort should be made to achieve a negative resection margin, because the type of resection, along with the nodal status, are the main predictors of long term survival in patients with locally advanced rectal cancer.