When is abdominal perineal resection (APR) indicated in the treatment of rectal cancer?

Updated: Apr 06, 2021
  • Author: Burt Cagir, MD, FACS; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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APR is performed in patients with lower-third rectal cancers. APR should be performed in patients in whom negative margin resection (see Table 2, below) will result in loss of anal sphincter function. This includes patients with involvement of the sphincters, preexisting significant sphincter dysfunction, or pelvic fixation, and sometimes is a matter of patient preference.

Table 2. Acceptable Minimal Distal and Proximal Resectional Margins for Rectal Cancer. [37, 62] (Open Table in a new window)

Resection Margins

Proximal Resection Margin

Distal Resection Margin

Ideal Margins

5 cm or more

2 cm or more

Minimally acceptable margins

5 cm or more

0.5-1 cm 

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