Abdominoperineal resection
An abdomino perineal resection, formally known as abdominoperineal resection of the rectum and abdominoperineal excision of the rectum is a surgery for rectal cancer or anal cancer. It is frequently abbreviated as AP resection, APR and APER. Indication and description. See image on National Cancer Institute website The principal indication for AP resection is a rectal carcinoma situated in the distal (lower) one-third of the rectum. Other indications include recurrent or residual anal carcinoma (squamous cell carcinoma) following initial, usually definitive combination chemoradiotherapy. APRs involves removal of the anus, the rectum and part of the sigmoid colon  along with the associated (regional) lymph nodes, through incisions made in the abdomen and perineum. The end of the remaining sigmoid colon is brought out permanently as an opening, called a stoma, which is used by the patient in conjuction with a colostomy pouch, on the surface of the abdomen. Centralisation of rectal surgery. This operation is one of the less commonly performed by general surgeons, although they are specifically trained to perform this operation. As low case volumes in rectal surgery have been found to be associated with higher complication rates, it is often centralised in larger centres, where  case volumes are higher. Laparoscopic approach. There are several advantages in terms of outcomes if the surgery can be performed laparoscopically Relation to low anterior resection (LAR). An APR, generally, results in a worse quality of life than the less invasive lower anterior resection (LAR). Thus, LARs are generally the preferred treatment for rectal cancer insofar as this is surgically feasible. Eponym. It is named for William Ernest Miles (1869–1947), an English surgeon who published his technique in a landmark paper in 1908.