✦ COLORECTAL SURGERY · RECTAL CANCER

Abdominoperineal Resection

Q: Is a permanent stoma inevitable after APR?

Yes — APR requires formation of a permanent end colostomy because the anus and sphincter complex are removed. Pre-operative stoma siting and specialist stoma care nursing significantly improve adjustment.

Q: What is extra-levator APR (ELAPE) and when is it used?

ELAPE carries the dissection along the outer surface of the levators before dividing them, producing a more cylindrical specimen with improved circumferential resection margin clearance. It is used selectively for low tumours close to or involving the levators.

Q: Will I need radiotherapy before or after APR?

Neoadjuvant radiotherapy or chemoradiotherapy is frequently recommended for mid and low rectal cancers before surgery to downstage the tumour and reduce local recurrence.

Combined abdominal and perineal excision of the rectum and anus for low rectal cancer — permanent end colostomy.

180–300 Min TREATMENT DURATION

7–10 Days CARE SETTING

Open APPROACH

6–8 Weeks RECOVERY TIMELINE

What is Abdominoperineal Resection?

Abdominoperineal resection (APR) is a combined abdominal and perineal operation for low rectal and anal canal cancers in which the rectum, anus, and sphincter complex are excised en bloc with formation of a permanent end colostomy. It is the procedure of choice when the tumour involves the sphincter or levator muscles. Dr. Tagore Mohan Grandhi performs APR using a combined laparoscopic abdominal and perineal approach. Modern extra-levator APR (ELAPE) techniques improve specimen quality and reduce the risk of intraoperative perforation in selected cases.

Indicated for low rectal cancers and anal canal tumours in which the sphincter complex is involved or adequate distal clearance cannot be achieved while preserving continence.

How the Procedure Works

Patient Positioning

Patient placed in modified Lloyd-Davies position under general anaesthesia, allowing simultaneous abdominal and perineal access.

Abdominal Phase

Sigmoid colon and rectum mobilised laparoscopically. Inferior mesenteric vessels divided. Total mesorectal excision performed. Permanent end colostomy formed in the left iliac fossa.

Perineal Phase

Circumferential perineal incision made around the anus. Dissection proceeds outside the external sphincter through the ischiorectal fat. ELAPE technique used for selected bulky tumours.

Specimen Removal and Closure

Intact specimen — rectum, sphincter complex, and mesorectum — removed via the perineum. Perineal wound closed primarily or with biological mesh repair.

Recovery

Enhanced recovery protocol commenced. Stoma care education provided pre- and post-operatively. Oncological follow-up as per multidisciplinary plan.

Outcomes

180–300 MinTREATMENT DURATION

7–10 DaysCARE SETTING

OpenAPPROACH

6–8 WeeksRECOVERY TIMELINE

Who Needs This Treatment?

→Achieves complete oncological clearance where sphincter preservation would compromise margins
→ELAPE technique improves specimen quality and reduces perforation risk in selected cases
→Laparoscopic abdominal phase minimises wound morbidity and accelerates recovery
→Multidisciplinary stoma care support optimises adjustment and quality of life

For patients with low rectal cancer where sphincter preservation is not oncologically appropriate, abdominoperineal resection provides the best chance of cure. Modern ELAPE techniques and comprehensive stoma support allow patients to return to a full and active life.

— Dr. Tagore Mohan Grandhi, Senior Consultant Gastrointestinal Surgeon, Lux Hospitals, Hyderabad

Common Questions

Frequently Asked Questions

Is a permanent stoma inevitable after APR?+

What is extra-levator APR (ELAPE) and when is it used?+

Will I need radiotherapy before or after APR?+

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