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APR vs Anterior Resection — SCE Medical Oncology MCQ

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ModerateGI CancersAPR vs Anterior ResectionSCE Medical Oncology

A 60-year-old man with rectal cancer has MRI showing a tumour at 3 cm from the anal verge. After neoadjuvant CRT he achieves a near-complete clinical response. He asks about permanent stoma implications. What determines whether he can have a sphincter-preserving (anterior resection) versus abdominoperineal resection (APR)?

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Correct answer: B — The key factors determining APR vs anterior resection are: distance from the anal verge (tumours <1-2 cm may require APR), involvement of the external anal sphincter/levator muscles on MRI, and tumour response to neoadjuvant CRT

The decision between sphincter-preserving surgery (low anterior resection with TME) and APR (permanent colostomy) depends on: (1) distance from the anal verge — adequate distal margin (≥1 cm after CRT) must be achievable; (2) involvement of the external sphincter/intersphincteric plane/levator muscles on MRI; (3) tumour response to CRT (downstaging may convert APR to sphincter-preserving); (4) patient factors (pre-existing incontinence). Intersphincteric resection extends sphincter-preservation to very low tumours in selected cases.

Reference: NICE NG151; ESMO 2024 Rectal Cancer