Abdominoperineal resection grossing

An addominoperineal resection specimen prior to opening and inking.

This protocol deals with abdominoperineal resection grossing.

Abdominoperineal resection, abbreviated APR, is also written as abdominal perineal resection.

Introduction

File:Abdominoperineal resection.jpg

An illustration of what is done in an abdominoperineal resection and the result.

This is a relatively uncommon specimen. APRs are done for distal rectal cancers when a lower anterior resection (LAR) is not feasible.

LAR are the preferred surgery for rectal cancer, as individuals post-APR are left with a permanent stoma and expel fecal material into a bag.

Protocol

Specimen:

• Abdominoperineal resection.

Dimensions:

• Length: ___ cm.
• Circumference - proximal end: ___ cm.
• Circumference - distal end: ___ cm.
• Rectum length (distal margin to mesorectal reflection): ___ cm.
• Skin (anal): ___ cm.

Appearance - external:

• Completeness of mesorectal excision: [complete].
• Serosal aspect of bowel: [shiny].
• Perforation: [present/not present].

Inking:

• Circumferential margin: [black].
• Serosal puckering: [blue].

Tumour characteristics:

• Dimensions (along axis, circumferential, depth): ___ x ___ x ___ cm.
• Distance to nearest mucosal margin: ___ cm, [distal] margin.
• Distance to circumferential margin: ___ cm.
• Circumferential location: [anterior/left/right/posterior/circumferential].

Representative sections are submitted as follows:

• Proximal margin. ‡
• Distal margin. ‡
• Tumour - deepest invasion.
• Additional sections of tumour (1 section/cm).
• All polyps (if less than 10).
• Normal appearing mucosa.
• Lymph nodes. †

Protocol notes

• ‡ Usually submitted completely and en face; if the margin is close (<2 cm) on edge is typically preferred.
• † Recommended minimum number of lymph nodes is 12.

Images

• 

  APR specimen - anterior view. (WC/Hagemani)

• 

  APR specimen - lateral. (WC/Hagemani)

• 

  APR specimen - inked (WC/Hagemani)

• 

  APR specimen - opened (WC/Hagemani)

See also

• Sigmoidectomy for diverticular disease.
• Donuts.
• Rectum.

Related protocols

• Lower anterior resection for cancer grossing.