Robert C. Wright, MD, PS
Informed Consent – Abdominal-Perineal
Resection / or Low Anterior Resection
We have determined that you have a cancer in your rectum demanding surgical treatment. The indication for
an abdominal-perineal resection or low anterior resection is usually due to a malignancy in the rectum or
pelvis. This procedure is performed only when it is felt that more conservative measures will not remove or
adequately control the cancer. An abdominal-perineal resection removes the rectum entirely and requires a
colostomy. A Low Anterior Resection can preserve anal function.
Description of the Procedure
Abdominal-perineal resection – the abdomen is opened in the midline and thoroughly examined for spread
of disease. The sigmoid colon and rectum are freed from surrounding structures. The colon is divided and a
colostomy is created. The rectum is then removed from below. The wounds are closed. Drain tubes may be
placed in the perineum, to be removed later. A tube is usually left in the bladder, temporarily. A colostomy
requires permanent bowel movements emptying from a bag on the belly.
Low Anterior Resection – this is performed similar to the abdominal-perineal resection. In addition, the
colon is moved in the rectal position and connected to the anus for normal bowel movements.
Additional procedures that may be done while in surgery
1.Resection of contiguous organs – If cancer is present and invading other organs, we will consider removing
them in order to adequately remove the tumor. This is usually done only if more aggressive surgery will
offer possible cure. The bladder, small bowel or uterus or vagina may be included.
2. Oophorectomy – the ovaries will usually be excised if present. This will lead to an early menopause if
you are still having periods.
Alternatives for Treatment
Alternative treatments will depend upon the nature of the cancer undergoing treatment. Radiation and/or
chemotherapy will temporarily resolve problems of obstruction, although the will usually come back.
Laparoscopy has not yet been shown to be effective for rectal cancer. Lesser transanal procedures have a
much higher cancer morbidity rate.
Risks/Complications of Treatment
In any medical treatment, it is impossible to predict all the things that could go wrong. Fortunately,
complications are the exception rather than the rule. Every reasonable effort is made to avoid complications.
The most common possible complications are as follows:
Possible complications of major surgery
1. Bleeding – this is a problem that could happen any time the skin is cut. Blood transfusions may be
needed.
2. Infection – we take special care to prevent an infection, but it is always a possibility. An infection
may require prolonged hospitalization and treatment to resolve.
3. Reactions to medications – this could be many things from a minor rash to possible death
4. Reactions to anesthesia and surgery – this could show up as a heart attack, blood clots, pneumonia,
sore throat, or potential death, in rare cases.
5. Poor wound healing – breakdown of the incision.
(see other side)
Possible complications following an abdominal-perineal resection or low anterior resection
1. Problems with healing in the perineum – this is a problem of healing in the area where the anus used
to be. Sometimes this may lead to a prolonged open wound in this area. This is more common after
radiation.
2. Breakdown of the colostomy/ileal conduit – the colostomy or ileal conduit will occasionally have
problems, leading to the need for further surgery.
3.Recurrence of the cancer – this could occur within the pelvis, or elsewhere in the body. Cure cannot
be guaranteed.
4. Sexual dysfunction
Anticipated Recovery/Expected Rehabilitation
Recovery is quite variable, depending on the individual and the disease being treated. Hospitalization
typically extends from seven to 21 days. Recovery to return of full preoperative function usually takes two
or three months or more. Recovery is strongly influenced by your medical status before surgery, and the
need for further treatments after surgery. You may have a colostomy for the rest of your life. It will be
impossible to reverse the surgery at a later date.
Further treatment of a cancer (should you have one) may be required, including chemotherapy and
possibly radiation therapy. The final pathology report after surgery will influence this decision.
Consent for Treatment
I understand my need for an abdominal-perineal resection or low anterior resection. I have read and
understand the above explanation of the procedure being proposed. My surgeon has answered my
questions, and I choose to proceed with surgery.
I understand that every operation may yield unexpected finding. I give the surgeon permission to act
on his best judgment in deciding to remove or biopsy tissues that appear to be diseased, understanding
that complications may arise from that action.
I understand that while most people receiving an abdominal-perineal resection or low anterior
resection benefit from the operation, I may not. My condition may not improve, and it may worsen.
No absolute guarantee can be made.
HIPPA: Before and after surgery, unless otherwise requested in writing by you, visitors whom you
invite to attend the surgery will be informed of the surgical finding, your surgical status, and
anticipated recovery issues for effectiveness of communications. Because of the anesthetic, you may or
may not remember these important details
PRINT NAME OF PATIENT __________________________________________________________________
SIGNATURE __________________________________________________________ DATE _________________
WITNESS ____________________________________________________________ DATE _________________
SURGEON ____________________________________________________________ DATE _________________
RELATIONSHIP TO PATIENT IF SIGNATURE OF LEGAL GUARDIAN ___________________________________
I waive the right to read this form, and do not want to be educated and informed of treatment risks;
nonetheless I understand the need for this surgery and grant permission to the surgeon to proceed on
my behalf.
SIGNATURE _____________________________________________________ DATE _________________
04/04rev