ABSTRACT
This paper had an enormous impact on the surgical community, and ‘Miles’ operation’ became the gold standard procedure for all rectal carcinomas for many decades. The concept of removing the entire rectum and the anus in all patients with rectal cancer gradually changed with time, however, and the increasing experience with bowel reconstruction, including the development of stapling instruments, led to the new concept of anterior resection and low anterior resection, which became the standard procedures for tumours in the upper and middle rectum.2-6
For tumours in the lower rectum, most surgeons continued to perform abdominoperineal excision (APE), although the extensive perineal approach described by Miles was more or less forgotten and the synchronous combined APE was introduced as a feasible procedure, which became popular and gained widespread use in the treatment of low rectal cancer.7 During the synchronous combined operation, the perineal part is carried out simultaneously with the pelvic part of the abdominal procedure, with the patient in the supine lithotomy or Lloyd Davies position. The rectum with its mesorectum is first mobilized down to the pelvic floor; the perineal surgeon then enters the pelvic cavity just in front of the coccyx, the levator muscles are divided on both sides, and the rectum is dissected off the prostate or the vagina and the specimen delivered through the perineum.
