Perineal Dissection of Synchronous Abdominoperineal Resection of the Rectum

Khatri, Vijay P.; Rodrı́guez-Bigas, Miguel A.; Petrelli, Nicholas J.

doi:10.1001/archsurg.138.5.553

Cited by 9 publications

(5 citation statements)

References 17 publications

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“…Major complications can occur after APR, which involves resection of the levator ani [75]. The extensiveness of pelvic dissection is directly related to the severity of subsequent bladder and genital dysfunction.…”

Section: Resultsmentioning

confidence: 99%

Where does pelvic nerve injury occur during rectal surgery for cancer?

Moszkowicz

Alsaid²,

Bessède³

et al. 2011

Colorectal Disease

111

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Section: Resultsmentioning

confidence: 99%

Where does pelvic nerve injury occur during rectal surgery for cancer?

Moszkowicz

Alsaid²,

Bessède³

et al. 2011

Colorectal Disease

111

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“…In male patients, the anorectum is closely apposed to the membranous urethra, prostate, and seminal vesicles thus making this dissection difficult. 2 In addition to having an intimate understanding of perineal regional anatomy, authors have suggested measures to avoid urethral injury including starting the anterior dissection from the side and not the midline and angling dissection downwards in an imaginary line towards the sacral promontory with intermittent palpation of a urinary catheter as a guide to stay in the safe plane. 2 To avoid injury to the membranous urethra, the transverse peronei and bulbocavernosus muscle must be clearly delineated, and dissection should remain dorsal to it.…”

Section: Discussionmentioning

confidence: 99%

“…2 In addition to having an intimate understanding of perineal regional anatomy, authors have suggested measures to avoid urethral injury including starting the anterior dissection from the side and not the midline and angling dissection downwards in an imaginary line towards the sacral promontory with intermittent palpation of a urinary catheter as a guide to stay in the safe plane. 2 To avoid injury to the membranous urethra, the transverse peronei and bulbocavernosus muscle must be clearly delineated, and dissection should remain dorsal to it. Any misjudgement during sharp dissection may result in the inadvertent opening of the membranous urethra or the 5 Studies have demonstrated a high perforation rate ranging from 8% to 26% in APR.…”

Section: Discussionmentioning

confidence: 99%

“…1 This makes the anterior dissection more difficult, because the anorectum is closely apposed to the membranous urethra, prostate, and seminal vesicles. 2 Irradiation induces a premature terminal differentiation process of the fibroblast/fibrocyte cell system resulting in the enhanced synthesis of interstitial collagens. 3 This severe fibrotic reaction leads to obliteration and destruction of anatomical and surgical planes.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prostatic Marker Needles to Define the Anterior Dissection Planes during APR for Rectal Cancers in Patients with Previous Radiotherapy for Prostate Cancer

Juta

Subhas

Makarawo

et al. 2012

Journal of Gastrointestinal Surgery

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“…There is therefore no need to define perineally the anterior plane in the midline which in reality does not exist. In the prone position and in laparoscopic operations little guidance can be obtained abdominally [56].…”

Section: Surgical Techniquementioning

confidence: 99%

Can the results of anorectal (abdominoperineal) resection be improved: are circumferential resection margins too often positive?

Radcliffe

2006

Colorectal Disease

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Carefully executed surgery for rectal cancer has reduced the incidence of local recurrence after restorative resection. Three recent large prospective series have confirmed the perception of a higher positive circumferential resection margin (CRM) rate after abdominoperineal resection. Tumour spread is different for low tumours and the surgical technique of abdominoperineal resection, perhaps better known as anorectal excision, may vary between surgeons. There is a need to redefine the place of anorectal excision and the contribution that can be made by pre-operative chemoradiation and/or extended surgery to reduce local recurrence and increase survival. Defined surgery, validated by histopathological assessment, as applied to TME surgery, would determine whether the perceived higher rates are due to the differences in routes of tumour spread or to surgically related variables. Unnecessary R1 or R2 resections and operative perforation can be minimized by an understanding of the surgical anatomy, the pattern of spread and difference in operative technique between anorectal excision and a low restorative operation. Surgical technique to maximize R0 resection should be based on a detailed understanding of the pelvic fascia and the levator ani and the use of pre-operative imaging to define lines of excision. With the adoption of even lower restorative resection (intersphincteric) there is a need to reassess the method of anorectal excision. This may be achieved by histopathological assessment of CRM positivity and MDT audit to improve results. Clinical trials are essential.

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Perineal Dissection of Synchronous Abdominoperineal Resection of the Rectum

Cited by 9 publications

References 17 publications

Where does pelvic nerve injury occur during rectal surgery for cancer?

Where does pelvic nerve injury occur during rectal surgery for cancer?

Prostatic Marker Needles to Define the Anterior Dissection Planes during APR for Rectal Cancers in Patients with Previous Radiotherapy for Prostate Cancer

Can the results of anorectal (abdominoperineal) resection be improved: are circumferential resection margins too often positive?

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