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

Background: 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.

Materials And Methods: 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.

Results: 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.

Conclusion: 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.