ABSTRACT
The surgical operations for rectal cancer were through a posterior parasacral approach via the perineum and the techniques used were mainly extra-peritoneal. The intraoperative and post-operative mortality was high, the post-operative functional results extremely poor and local recurrence rates amounted up to 95%. One obvious problem associated with the conventional type of synchronous combined abdomino-perineal excision (APE) is the lack of standardisation. Although the abdominal part of the operation follows the standard total mesorectal excision principles, there has been no obvious agreement on the surgical details of the perineal part of the operation. This probably explains the significant variability in the observed rates of tumour-involved margins, bowel perforations and subsequent local recurrence rates and survival. All patients planned for an APE should be well informed about the extent of the procedure, the potential complications that may occur post-operatively and the possible late sequel, such as urogenital dysfunction and stoma problems that they may have to live with.
