Our Summary

This study looked at different surgical methods used for rebuilding the area around the anus (perineal area) after it has been removed due to rectal cancer. The researchers found that the most common method used was one that involved using tissue from the abdomen. However, they also found that results were similar whether the tissue used was from the abdomen, thigh or the perineal area itself. The study did highlight that it’s hard to pick out small differences in how successful each method is due to factors like the way the study was run, the relatively short follow-up period, and potential bias in the selection of surgical techniques based on associated risks. The study concluded that there isn’t a one-size-fits-all approach to this type of surgery, and that doctors should tailor their surgical plans based on each individual patient’s needs.

FAQs

  1. What is abdominoperineal resection (APR) and when is it used?
  2. What are the different techniques used for perineal reconstruction following APR?
  3. What factors should clinicians consider when deciding on the best approach for perineal reconstruction?

Doctor’s Tip

One helpful tip a doctor might tell a patient about proctectomy is to discuss with their surgeon the different options for perineal reconstruction following the procedure. It is important to understand the potential risks and benefits of each approach and to work with the surgical team to determine the best option for individual circumstances. Additionally, patients should be aware that there is no consensus on the optimal approach for perineal reconstruction, so it is important to have open communication with the medical team throughout the process.

Suitable For

Patients typically recommended for proctectomy include those with anorectal carcinomas, inflammatory bowel disease, rectal prolapse, and other conditions that require removal of part or all of the rectum and anus. These patients may experience symptoms such as rectal bleeding, pain, incontinence, and obstruction that do not respond to conservative treatments. Proctectomy may be recommended as a curative treatment for anorectal cancer or as a palliative treatment for advanced disease or severe symptoms. Additionally, patients with genetic conditions such as familial adenomatous polyposis (FAP) may undergo proctectomy as a preventive measure to reduce the risk of developing colorectal cancer.

Timeline

Before proctectomy:

  • Patient is diagnosed with anorectal carcinoma
  • Patient undergoes preoperative evaluations, such as imaging studies and blood tests
  • Patient receives counseling on the procedure and potential complications
  • Patient undergoes bowel preparation to empty the colon
  • Patient may receive neoadjuvant therapy, such as chemotherapy or radiation

After proctectomy:

  • Patient undergoes the surgical procedure, which involves removal of the rectum and anus
  • Perineal reconstruction is performed using flap-based techniques, such as rectus abdominis, myocutaneous, gracilis, or gluteal flaps
  • Patient is monitored in the hospital for postoperative complications, such as infection or bleeding
  • Patient may require a temporary colostomy or ileostomy to allow the surgical site to heal
  • Patient undergoes postoperative follow-up appointments to monitor recovery and assess for any signs of recurrence or complications.

What to Ask Your Doctor

  1. What is the reason for recommending a proctectomy?

  2. What are the potential risks and complications associated with the procedure?

  3. What is the expected recovery time and post-operative care plan?

  4. Are there alternative treatment options to consider?

  5. What is the long-term prognosis following a proctectomy?

  6. Will I need additional surgeries or treatments after the proctectomy?

  7. How often will follow-up appointments be needed after the procedure?

  8. What can I expect in terms of quality of life after a proctectomy?

  9. Are there any lifestyle changes or restrictions I should be aware of following the surgery?

  10. Can you provide more information on the specific technique you will be using for the proctectomy and any potential reconstructive procedures?

Reference

Authors: Copeland-Halperin LR, Stewart T, Chen Y, Funderburk CD, Freed GL. Journal: J Plast Reconstr Aesthet Surg. 2020 Nov;73(11):1924-1932. doi: 10.1016/j.bjps.2020.08.090. Epub 2020 Sep 10. PMID: 32958425