Operated upon a carcinoma rectum T2N0M0 - 4 cm from anal verge
Abdomino perineal resection :
Points to know…
- Done for growth less than 6 cm from anal verge…
- The main indication is if the Puborectalis sphincter is unable to be preserved by giving 2 cm clearance.
- The clearance given for carcinoma rectum is distal lumen 2 cm and mesorectum 5 cm…
- For Lower rectal cancers we must do Total colorectal excision (as you are seeing like a Baby Buttock in the image is mesorectum intoto)
- There are two types of APR - Intersphincteric and Extralevator… I did a intersphincteric only…
- In cases of T3 and N1 we prefer neoadjuvant Radiotherapy but this is straight forward T2 and N0 and hence surgery proceeded straight forward…
The biopsy report came as T2 N0 …
Stage I as per biopsy report … so no post op chemo RT will be given for this patient…
He will be on follow up with CEA 3 monthly, Colonoscopy yearly and CT abdomen yearly for 5 years…
Following APR problems are
- Patient has to live with permanent colostomy and hence it has it’s own list of complications.
- Following AR and APR we expect some erection problems and sexual discomforts as there may chances of Inferior Hypogastric nerves injury…
- Some patients may also have Bladder emptying issues.
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Thank you
By
Dr. R.Rajamahendran
MS, MRCS, MCh ( Gastro)
RRM Gastro Superspeciality Clinic
Villupuram…