Abdomino-Perineal Resection for Low Rectal and Anal Malignancies in Ibadan, SOUTHWEST NIGERIA

Colonic tumours are the third most common tumours in the Nigerian cancer registry after breast and cervical carcinoma. Tumours involving the distal rectum and anus are increasingly a significant portion of all colorectal and anal malignancies in Nigeria. The patients frequently present with advanced disease. Abdomino-Perineal resection (APR), is thus an essential modality of treatment alongside chemo-radiation. The aim of the study was to review the surgical outcomes of APR done for low rectal and anal malignancies in a resource poor setting in sub-Saharan Africa.

The demographic data, clinical features, management offered and outcomes of all patients who had had abdomino-perineal resection for colonic and anal malignancies at the University College Hospital, Ibadan, Nigeria between 2007 and 2013 were included in this study.

Over the 6-year period, 61 patients had abdomino-perineal resection for low colonic and anal malignancies in our institution. The indications were primary rectal carcinoma in 46 (75.4%) patients and anal carcinoma in 15 (24.6%) patients. The age ranged from 19-77 years with a mean of 48 years and median of 54 years. Majority were males in 33 (54.1%) patients. A fifth (20%) of the patients presented as emergency with large bowel obstruction that necessitated initial colostomy. Bleeding per rectum in 45 patients (73.8%), Weight loss in 26 patients (42.6%) and Tenesmus in 16 patients (26.2%) patients were the predominant complaints. All the patients were at stage AJCC 2A-3C (Duke Stage C or D) at presentation. Almost a third (66%) of the patients was incontinent of feaces. Palliative surgery was done for all the patients. The duration of follow up was between 3-36 months with a mean of 22 months. A total of 53 (86.9%) patients are alive after an average post-operative duration of 24 months, with 14 pts (23%) having local recurrence, and 22(36.1%) patients with hepatic metastases. Lymph nodal involvement was statistically significantly related to the survival status of the patients. Neo-adjuvant and adjuvant chemo-radiation did not affect outcomes in terms of local recurrence and survival.

Abdomino-perineal resection is still the option of treatment in this environment for low rectal and anal malignancies in this environment. Early presentation and effective treatment shall improve the outcome.