| Abdominoperineal resection (APR) of the rectum and anus for rectal cancer continues to have greater local recurrence and poorer survival than that seen following anterior resection. Changing to an extended prone perineal dissection results in a more cylindrical specimen and should improve outcomes.Material and methodsFrom February to May in 2009,6 patients with low rectal cancer were received in General Surgery, qilu hospital, Shandong Province.1 case of males,5 females, aged from 47 to 65 years, with an average age of 57. Distance from the lower margin of tumor to the anal verge is 2～5cm, preoperative staging by MRI examination, T3 3 cases, T4 3 cases,2 patients received neoadjuvant chemotherapy (XELOX program 2 cycles, 25 radiotherapy, total dose 50gy, rest for 6 weeks after surgery).Surgical methodsThe procedure involves careful mobilization of the mesorectum only as far down as the origins of the levator muscle, protection of ureter and hypogastric nerve and pelvic plexus.After stoma formation, the abdomen is closed, the patient is rotated into the prone position, and an extended perineal dissection is performed. This includes the sphincter complex and follows the inferior surface of the levators to a point laterally where they originate on the pelvic sidewall. This point should be just inferior to the level where the abdominal procedure was terminated. The coccyx is often removed in continuity with the main specimen to improve direct visualization of the dissection.ResultThe cylindrical technique removed more tissue in the distal rectum. There was no bowel perforation, perineal wounds were uneventfully. One patient developed perineal seroma. One patient developed peritoneocele hernia of pelvic floor.ConclusionCylindrical APR performed in the prone position for low rectal cancer removes more tissue around the tumor that leads to a reduction in CRM involvement and intraoperative perforations, which should reduce local disease recurrence.
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