Preliminary Study Of Extensive Abdominoperineal Resection

Objective:With the development of pathology and chemoradiotherapy,pelvic autonomic nerve preservation and the standardization of the TME technique using in low rectal cancinoma,improved radical abdominoperineal resection in patients with long-term survival rate and quality of life.Much recent literature show that compared with the anterior resection of rectal cancer resection,local recurrence rate of abdominoperineal resection remains high.Considering the total mesorectal excision only stay above the levater muscles plane,and the operation of perineum is not a normative excision method,this may be the reason.Base on the different vascular distribution and lymph node metastasis ways of low rectal cancer,we conducted the extensive abdominoperineal resection.This study aims to review the 58 patients,who underwent the extensive abdominoperineal resection and traditional abdominoperineal resection in the intestinal surgery department of Sichuan cancer hospital,and then by Investigating the intraoperative situationg,the incidence of postoperative complications,local recurrence rate,to study the feasibility and advantage of the extensive abdominoperineal resection.the blood and lymph node metastasis ways,we conducted a joint rectum abdominal perineal resection Vascular supplydistributionextensive This study aims to review the hospital has expand abdomen perineum joint rectum resection with traditional abdominal perineal resection of rectal cancer,patients traditional.Methods:general data:5 8 patients with progressive low rectal cancer who underwent the operation in the intestinal surgery department of Sichuan cancer hospital between January 2010 and December 2011,were enrolled in this retrospective study.30 patients underwent the extensive abdominoperineal resection,28 patients underwent the traditional abdominoperineal resection.Preoperatively,patients underwent magnetic resonance imaging for staging of the rectal cancer.All patients with clinical staging of T3 N1-N2 or T4 tumors received neoadjuvant chemoradiotherapy.Patients with a T4 tumor or lymph node metastases received postoperative systemic chemotherapy.All the patients were regularly review and reexamine,and we collected the results of postoperative follow-up records.By analyzing two kinds of operation mode of operation time,intraoperative blood loss,postoperative bowel perforation rate perineal incision infection rate,incidence of voiding dysfunction after operation,postoperative local recurrence rate,and carries on the comparative evaluation.operation methods:surgery patients take bladder lithotomy position,two groups of abdominal surgery operation with a traditional APR,was performed according to the technical of the total mesorectal excision(TME).During the abdominal surgery operation,we need protect the ureter and pelvic autonomic nerve.Pelvic dissection is stopped before the mesorectum is dissected off the levator ani muscles.After finishing the abdominal surgery operation,we make the permanent colostomy outside the peritoneum.Perineal operation:extensive group:close the anus,follow the mark of ischial tuberosity,gluteus maximums and perficial fascia transverse muscle of perineum as the boundary,deep to remove fat of ischial rectal fossa.The levator animuscles were divided laterally at its insertion onto the pelvic side wall on both side.Traditional group follow the operation of traditional abdominoperineal resection.Results:All the patients got radical excision of the teams.There was no intraoperative death case.There was no difference between the two teams of the average operation time(extensive team 205 minutes,traditional group 220 minutes P=0.12),urinary dysfunction(extensive team 2 patients,traditional group 2 patients,P?0.632).Intraoperative blood loss difference was statistically significant(extensive team an average of 200 ml,traditional group an average of 300 ml,P?0.01).Extensive group average follow-up time of 30 months(16 to 40 months),the traditional group average follow-up time of 28 months(14 to 36 months).1 case occurred local recurrence of wall on the left side of the pelvic wall in 18 months after surgery,four patients appeared distant metastases,Three cases with liver metastases,one case of liver and lung metastasis in the extensive team.Four case occurred local recurrence,patients appeared distant metastases,distant metastasis(five),including two cases of liver metastasis,three cases of pulmonary metastasis.Extensive group and traditional group differences in local recurrence rate(3.3%vs 14.3%,P<0.05).Conclusions:Compared with traditional abdominal perineal resection of rectal,Extensive abdominoperineal resection is without any increase in patients with postoperative complications,such as postoperative urination dysfunction and perineal incision infection rate,and decrease the intraoperative blood loss,reduce the postoperative local recurrence rate without increased the postoperative complications,such as postoperative urinary dysfunction and perineal incision infection rate.