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| X = complete * = partial o = optional • = see note under procedure |
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------Tissues Removed----- |
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| Rectum | Recto-sigmoid | Lymph nodes | Sphincter | Other Organs# | Permanent Colostomy | |
| Local tumor destruction without specimen Includes cryosurgery, fulguration, laser surgery (vaporization), electrocautery |
* | |||||
| Local excision with pathologic specimen Includes endoscopic snare, excisional laser surgery, polypectomy |
* | |||||
| Partial proctectomy | X | |||||
| Rectal resection, Not Otherwise Specified | X | X | X | o | ||
| Wedge or segmental resection | X | o | o | |||
| Transsacral rectosigmoidectomy | X | X | X | |||
| Hartmann's operation | X | X | X | rectal- pouch |
descen-ding | |
| Anterior/posterior resection | X | X | X | |||
| Pull-through resection with sphincter preservation; includes: Altemeier's operation, Soave's submucosal resection |
X | o | X | |||
| Duhamel's operation | X | X | X | sigmoid | ||
| Swenson's procedure | X | X | X | * | ||
| Turnbull procedure | X | o | X | pre- served |
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| Abdomino-perineal resection (complete proctectomy) descending • anus, perineal skin, fat and nerves |
X | X | X | X | • | X |
| Miles' operation • perianal excision of rectum and anus |
X | X | X | X | • | X des- cending |
| Rankin's operation | X | o | X | X | X | |
| Pelvic exenteration (partial or total) | X | o | X | X | X | X |
| Surgery of regional and/or distant sites or nodes | */X | |||||
# Other organs may include bladder, prostate, pelvic contents, bony pelvis, pelvic blood vessels, ligamentous attachments
There is no published guideline for determining whether this abbreviation refers to Anterior/Posterior or Abdominoperineal resections, but some of the distinguishing characteristics are listed below.
Abdominoperineal resection is performed for very low lesions in the rectum (lower third--within 5 cm of anal verge). An abdominoperineal resection, in addition to removing the entire rectum, most of the sigmoid colon, the mesocolon and its regional lymph nodes, removes the anal sphincter and leaves the patient with a permanent colostomy. Because of the resulting colostomy, this procedure is done only in circumstances where it is absolutely necessary. This procedure may also be called a Miles’ or a Rankin’s procedure. Review the x-rays, endoscopy, op report and/or path report for an indication that the tumor is very low in the rectum or that the path specimen contained the anal sphincter muscle. An enterostomal therapist report may also give you some indication that the patient will have a permanent colostomy.
Anterior/Posterior resection is performed for other lesions in the rectum and rectosigmoid (above 5 cm from anal verge). This procedure is usually called a low anterior resection, but may have a posterior approach in certain situations. An Anterior/ Posterior resection preserves the anal sphincter and preserves bowel continuity by creating an anastomosis after the segment of bowel containing the tumor is removed. You will see references to autosuture devices or intraluminal stapling devices in the op report as the anastomosis is constructed. The patient may have a temporary colostomy which is closed at a later date.
The general guideline is to look at the location of the tumor: if it is below 5 cm from the anal verge, AP probably stands for Abdominoperineal; if it is above 5 cm, it probably means Anterior/Posterior.