Operated upon a carcinoma rectum T2N0M0 - 4 cm from anal verge


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Operated upon a carcinoma rectum T2N0M0 - 4 cm from anal verge

Abdomino perineal resection :

Points to know…

  1. Done for growth less than 6 cm from anal verge…
  2. The main indication is if the Puborectalis sphincter is unable to be preserved by giving 2 cm clearance.
  3. The clearance given for carcinoma rectum is distal lumen 2 cm and mesorectum 5 cm…
  4. For Lower rectal cancers we must do Total colorectal excision (as you are seeing like a Baby Buttock in the image is mesorectum intoto)
  5. There are two types of APR - Intersphincteric and Extralevator… I did a intersphincteric only…
  6. 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

  1. Patient has to live with permanent colostomy and hence it has it’s own list of complications.
  2. Following AR and APR we expect some erection problems and sexual discomforts as there may chances of Inferior Hypogastric nerves injury…
  3. 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…