Our Summary

This research paper discusses the challenges of managing low rectal cancer, specifically the difficult decisions involved in whether to perform a surgical procedure called an abdominoperineal resection (APR) for patients with tumors located low in the rectum. It also explores how to adjust the surgical approach based on the specific characteristics of the tumor and the patient’s individual goals.

The paper provides guidance on how to select suitable patients, how to plan the surgery, and the specific surgical techniques needed to perform three types of APRs for treating rectal cancer. These three types are extrasphincteric, extralevator, and intersphincteric resections.

The study takes into account not just traditional outcomes such as recurrence of the cancer and patient survival rates, but also how the patient perceives their own recovery and quality of life after the surgery.

FAQs

  1. What are the three types of abdominoperineal resections for rectal cancer?
  2. How does tumor anatomy and patient goals affect the surgical approach for an abdominoperineal resection?
  3. What factors are considered in patient selection and preoperative planning for abdominoperineal resection?

Doctor’s Tip

One helpful tip a doctor might tell a patient about proctectomy is to follow postoperative care instructions closely, including proper wound care and pain management, to ensure a successful recovery. It is also important to attend all follow-up appointments and communicate any concerns or symptoms to your healthcare provider promptly. Additionally, maintaining a healthy lifestyle, including regular exercise and a balanced diet, can help improve overall surgical outcomes and quality of life.

Suitable For

Patients with low rectal cancer are typically recommended proctectomy, specifically abdominoperineal resection (APR), when the tumor is located close to the anal sphincter and cannot be safely removed using less invasive procedures. The decision to perform an APR may be based on factors such as tumor size, location, and invasion into surrounding tissues, as well as patient preferences and goals. Patients may also be recommended proctectomy if they have recurrent or advanced rectal cancer that has not responded to other treatments.

Patients who undergo proctectomy may experience improved quality of life and reduced risk of cancer recurrence, although the procedure can have significant physical and emotional impacts. It is important for patients to discuss their options with their healthcare team and consider the potential benefits and risks of proctectomy before making a decision.

Timeline

  • Before proctectomy:
  1. Patient is diagnosed with low rectal cancer.
  2. Patient undergoes various imaging tests and consultations with healthcare providers to determine the best course of treatment.
  3. Patient may undergo neoadjuvant therapy such as chemotherapy and/or radiation to shrink the tumor before surgery.
  4. Patient discusses with their healthcare team about the possibility of needing an abdominoperineal resection (APR) based on tumor anatomy and individual goals.
  5. Patient undergoes preoperative planning and preparation for surgery.
  • After proctectomy:
  1. Patient undergoes abdominoperineal resection surgery to remove the rectum and anus.
  2. Patient may experience pain and discomfort postoperatively, and will be monitored closely for any complications.
  3. Patient begins the recovery process, which may include physical therapy and wound care.
  4. Patient may require a temporary or permanent colostomy to divert stool from the body.
  5. Patient undergoes follow-up appointments and monitoring to assess for recurrence and overall recovery.
  6. Patient works with healthcare team to manage any long-term effects of the surgery and adapt to life with a colostomy.

What to Ask Your Doctor

  1. What are the different types of abdominoperineal resections for rectal cancer and which one would be most appropriate for my case?
  2. What are the potential risks and complications associated with a proctectomy?
  3. How will a proctectomy affect my quality of life and daily activities?
  4. What is the expected recovery time and post-operative care following a proctectomy?
  5. Are there any alternative treatment options to consider before proceeding with a proctectomy?
  6. How will a proctectomy impact my ability to control bowel movements and bladder function?
  7. What is the long-term prognosis for patients who undergo a proctectomy?
  8. Will I need additional treatments such as chemotherapy or radiation therapy following the proctectomy?
  9. How often will I need follow-up appointments and monitoring after the proctectomy?
  10. Are there any lifestyle changes or modifications that I should make before or after the proctectomy procedure?

Reference

Authors: Hawkins AT, Albutt K, Wise PE, Alavi K, Sudan R, Kaiser AM, Bordeianou L; Continuing Education Committee of the SSAT. Journal: J Gastrointest Surg. 2018 Aug;22(8):1477-1487. doi: 10.1007/s11605-018-3750-9. Epub 2018 Apr 16. PMID: 29663303