Abdominoperineal combined radical resection for rectal cancer

Abdominoperineal combined rectal cancer radical resection (Miles operation) is suitable for rectal cancer located at a lower position and below the peritoneal fold. During the operation, the patient is in the lithotomy position, and the resection range includes the distal sigmoid colon, the entire rectum, the inferior mesenteric artery and its regional lymph nodes, the entire mesorectum, the levator ani muscle, the fat in the ischiorectal fossa, the anal canal, and the skin, subcutaneous tissue and all anal sphincters about 3 to 5 cm around the anus. During the operation, pay attention to protecting the ureter, hypogastric nerve and pelvic nerve. After cutting the intestinal tube, a permanent sigmoid colon single-lumen stoma (artificial anus) is made in the left lower abdomen. A drainage tube is placed in front of the sacrum and led out from the perineal incision. The subcutaneous fat layer and skin are sutured. There have been reports on the use of gracilis or gluteus maximus to replace the sphincter for in situ anoplasty after abdominoperineal combined rectal cancer radical resection, but the efficacy of this trial method has yet to be confirmed.

This surgical procedure has a wide resection range, complete lesion resection, and a high cure rate. The two-year survival rate after surgery can reach 90%. However, the operation is relatively complicated to implement and the side effects are relatively large. There are many postoperative complications such as presacral bleeding, intestinal obstruction, anastomotic fistula, and abdominal incision rupture. The fistula heals slowly, affecting the patient's quality of life and placing a great psychological burden on the patient. Many patients show signs of depression.