While the rate of sphincter-preserving surgery for rectal cancer has increased, approximately one-fifth of patients will still require abdominoperineal excision (APE). Poor outcomes in some series have lead to suggestions that the oncological result in these patients is worse than in those undergoing anterior resection.1 Is this because of distinct tumor biology compared with more proximal cancers? There is some evidence to show that tumors treated with APE are more locally advanced. However, with optimized surgery and avoidance of either margin positivity or intraoperative perforation, outcomes with APE should be similar to those following anterior resection.2 Is it then that poorer outcomes following APE are a reflection of inadequate surgery, an uncomfortable truth for the surgical community?
Winter DC. Extralevator Abdominoperineal Resection for Low Rectal CancerNew Direction or Miles Behind?. Arch Surg. 2010;145(9):811-813. doi:10.1001/archsurg.2010.174