Abdominoperineal resection for rectal cancer: Historic perspective and current issues

The technique of APR has changed substantially in the past century, with significant improvements in early postoperative outcome, long-term oncologic outcome, and quality of life. APR, according to the principles of TME, has provided for substantial improvement in local failure and overall survival rates. In addition, when oncologically appropriate, APR performed with ANP can contribute to substantial improvements in postoperative genitourinary and sexual function. Experience with laparoscopic-assisted APR suggests that this procedure may provide for decreased postoperative morbidity, and appears safe and effective for rectal cancer resection. However, large, prospective studies are needed before definitive conclusions can be drawn. The future challenges in the management of a patient with rectal cancer felt to require an APR include the determination of the optimal use of chemoradiation and immunologic therapy, better definition of the role of laparoscopy, better understanding of the pathophysiology of bladder and sexual dysfunction, and further improvement in local and distant control of disease. It is important to recognize that a century after its introduction, APR remains a valuable procedure in the curative treatment of select patients with distal rectal tumors.