Extirpation of the rectum

Abdominal-perineal extirpation of the rectum (or Quenu-Miles operation) is a radical surgical treatment that involves the removal of the rectum, rectal adipose tissue and lymph nodes. At the end of the operation, the surgeon inserts a permanent colostomy into the anterior abdominal wall (an artificially created hole for removing feces) .

Indications for surgery

Quenu -Miles surgery is performed for rectal cancer (if the tumor is up to 3 cm), anal cancer, and rectal cancer recurrence.

Advantages of extirpation in EMC

Performing abdominal-perineal extirpation of the rectum

Extirpation of the rectum consists of two important parts – the intraperitoneal and perineal stages are distinguished.

With all methods of surgical intervention (laparoscopic, robotic, open), D3 lymphodissection is performed during the intra-abdominal stage, and the affected part of the intestine and lymph nodes are removed. Most often, the descending colon is removed above the resection level in the form of a stoma.

During the perineal stage of surgical treatment, the anus, sphincter, lymph nodes and the fiber that surrounds the anus are removed.

Extirpation of the rectum is performed by a robotic, laparoscopic or open method. The first two methods are the most modern minimally invasive operations, which make it possible to shorten the rehabilitation period, reduce pain and reduce the risk of postoperative complications. Therefore, if abdominal-perineal extirpation of the rectum can be performed by a robotic or laparoscopic method, these methods are preferred in the EMC.

Types of surgical method

Laparoscopy

Performing laparoscopic extirpation, the surgeon makes small punctures (from 5 mm to 1 cm) on the anterior abdominal wall and, thus, enters the rectum and removes the tumor. The operation is low-traumatic, with minimal blood loss and rapid rehabilitation.

Robotic operations

The removal of the rectum in a robot-assisted manner is an operation using a high–tech Da Vinci robot. High-resolution optics allows the surgeon to see the rectum and other organs in multiple magnification and perform extirpation with high precision.

Open operations

Removal of the rectum by open surgery is prescribed in the presence of contraindications (most often for diseases of the heart and lungs). The final decision on the method of surgery is made at an interdisciplinary oncological council of doctors individually for each patient.

Before extirpation, the surgical team examines the anatomy of blood vessels, the location of tumor tissue, and the innate features of blood vessels and nerves. During surgical treatment, this allows you to isolate the layer of the hypogastric plexus and, when resecting part of the colon and removing the neoplasm, do not harm the nerve endings.

At EMC, surgeons have extensive experience in performing nerve-sparing extirpations and have all modern technologies for dissecting (dissecting) the necessary tissues without damage. The surgeon has a Harmonic ultrasonic scalpel in his arsenal, which allows him to isolate tissue structures very subtly and accurately and not harm them. As a result of this approach, the patient will be able to avoid complications in the early postoperative period (urinary disorders, erectile dysfunction, pelvic organ dysfunction).

Preparation for abdominal-perineal extirpation of the rectum

Before surgical treatment, it is important to understand how affected other organs are. During a standard finger examination of the rectum, the proctologist identifies a tumor of the lower ampullary rectum or anal canal. A biopsy is then performed. The proctologist also refers the patient for a colonoscopy and гастроскопию to understand if the tumor has penetrated into the colon. Computed tomography (CT) of the thoracic and abdominal cavities is necessary to exclude liver or lung metastases. The patient is then given a magnetic resonance imaging (MRI) scan: This study evaluates the depth of damage to the mucous, submucosal and muscular layers of the rectum and regional lymph nodes. All these diagnostic methods are necessary in order to determine the stage of colorectal cancer and choose the most effective treatment method.

You can prepare for surgery on an outpatient basis or in an EMC hospital. The day before the removal of the rectum, the intestines are cleaned with an enema or a special preparation. 

Possible complications

After extirpation of the rectum, infectious complications (peritonitis and suppuration) and bleeding after resection sometimes occur. There may also be cardiological complications such as myocardial infarction, pulmonary embolism, and stroke.

To avoid infectious complications, the EMC uses modern suturing devices, as well as ultrasound instruments, with which the surgeon performs dissection of tissues in the abdominal cavity during surgery. This helps to avoid bleeding after surgery. EMC surgeons have experience working in the world's leading clinics and use the most modern surgical techniques.

In order for the surgical treatment to be perfect, the EMC conducts extensive and very effective preoperative preparation of the patient for the removal of the rectum. These are examinations by an anesthesiologist, cardiologist and therapist, electrocardiogram (ECG), ultrasound examination of the heart and blood vessels of the lower extremities. This eliminates the risk of cardiac and neurological complications.

Rehabilitation period after surgery

1. On the first day after the operation, the patient is in intensive care: he can already independently perform turns to the right or left side and raise his head.
2. Breathing exercises are held daily.
3. If the patient is in stable condition, he is transferred to a hospital on the second day, where he is treated by a physiotherapist and a rehabilitologist. 
4. Under the supervision of doctors, the patient takes the first independent steps after extirpation of the rectum, learns to move within the ward without outside help, and begins to stand up straight. 
5. After open surgery, the patient stays in the hospital for about seven days, after laparoscopic and robotic surgery – for about five days.

Contraindications for extirpation

Extirpation of the rectum is impossible in the late stages of rectal cancer and in anal cancer with distant metastases to other organs (most often to the liver and lungs), in diseases of the cardiovascular system, liver or kidney failure, and in the active stage of tuberculosis.