Abdominoperineal resection
Removing the rectum and anus together, leaving a permanent colostomy. Used when a low rectal or anal cancer involves the sphincter.
The operation through both the abdomen and the perineum removes rectum, anal canal and sphincters, so a permanent end colostomy is unavoidable. For anal squamous cancer it is reserved as salvage after definitive chemoradiation (the Nigro regimen) fails; for low rectal cancers it is being displaced by sphincter-preserving TME, intersphincteric resection and organ-preservation strategies. Perineal wound problems are common and flap reconstruction is often needed.
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