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Numbness over the anterior thigh
2%
1/46
Erectile dysfunction
78%
36/46
Paresthesias in the distal lower extremities
0%
0/46
Inability to flex at the hips
Numbness over buttocks and posterior thigh
15%
7/46
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This patient has a distal colorectal tumor that necessitates an abdominoperineal resection. One of the complications specific to this procedure is damage to the nerves involved in achieving and sustaining an erection. Abdominoperineal resections (APRs) encompass the resection of the sigmoid colon, rectum, anus and the construction of a permanent end-colostomy. Indications include anal cancers, distal rectal cancers with sphincter involvement, ulcerative colitis, and Crohn's proctitis with anal disease. Procedure-specific complications can be categorized into nerve injury, urologic injury, and perineal wounds. Peroneal nerve injury from incorrect stirrup use, autonomic nerve injury affecting both sexual and urinary function, and hypogastric nerve injury during dissection over the sacral promontory are all possible during surgery. Sexual dysfunction in men presents as the inability to achieve erection, partial erection, or retrograde ejaculation. Postoperative radiation also can exacerbate male sexual dysfunction. Pidala et al. report on local treatment versus abdominoperineal resection for rectal cancer. Although most distal tumors require an APR, there are still some select distal tumors that can be treated locally. Sphincter-saving treatments of rectal cancers include excision, electrocoagulation, or contact radiation. These local procedures have been shown to have much less morbidity and mortality as compared to APRs. Close follow-up of those patients treated with local measures is still essential, as tumor recurrence is still possible. Perry et al. discuss abdominoperineal resections. APRs are not as widely used as they have been in the past because of recent advancements in surgical techniques that allow for sphincter-sparing procedures. However, in some patients with distal tumors or poor sphincter function, an APR procedure is still indicated. The risk of postoperative sexual or urinary dysfunction can range from 10 to 60%. Illustration A depicts an artist's rendition of an abdominoperineal resection. The top image is of a distal rectal tumor, and the bottom image is post-operative findings. Video V is an animation depicting the overview of an abdominoperineal resection of the colon. Incorrect Answers: Answers 1, 3-5: None of these nerve injury outcomes would be expected as common sequelae of an abdominoperineal resection.
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