LAPAROSCOPIC ABDOMINOPERINEAL RESECTION WITH SACRECTOMY: TECHNICAL DETAILS AND PITFALLS

INTRODUCTION

A total of 16,660 new cases of colon and rectum cancer in men and 17,620 in women are estimated for 2016 in Brazil². In locally advanced rectum cancer, survival after R0 resection is very good, and exenteration should be offered to patients with advanced primary or recurrent tumor, where resection is necessary in addition to total excision of the conventional mesorectum⁶. In the case of invasion of the sacrum, excision with free margins greatly increases the morbidity and radicality of the procedure, posing a challenge to the surgeon.

To date, the highest level of evidence for the benefits of the laparoscopic approach in rectal cancer comes from the Corean Trial⁵ and NCCN⁶ studies. However, the literature lacks data to justify the use of laparoscopy in locally advanced tumors. In Brazil, there is no report of abdominoperineal resection associated with videolaparoscopic sacrectomy.

The purpose of this report is to present an alternative for the treatment of malignant rectal cancer with posterior invasion involving a combined anterior laparoscopic approach and subsequent tumor resection.