What is the surgical procedure of choice for anal-rectal adenocarcinoma?

The surgical procedure of choice for anal-rectal adenocarcinoma is abdominoperineal resection (APR). This procedure is specifically indicated for cancers located within the anal canal and involves the surgical removal of the anus, rectum, and a portion of the sigmoid colon, along with the surrounding tissue. The operation also necessitates the creation of a permanent colostomy, as the rectum and anus are no longer present to facilitate normal elimination.

APR is deemed the most effective method for managing anal-rectal adenocarcinoma because it ensures complete excision of the tumor while aiming to reduce the risk of local recurrence. This approach is particularly important since adenocarcinomas can spread locally in the anal region. By removing the entire area affected by the cancer along with a margin of healthy tissue, the surgeon optimizes the chances for long-term survival.

In contrast, other surgical options listed, such as colectomy, fistulectomy, and local excision, are not appropriate for treating anal-rectal adenocarcinoma due to factors such as inadequate tumor removal or failure to address the specific anatomical considerations of the anal canal and surrounding structures.