Two vs. Three-Stage Abdominoperineal Resection in Rectal Cancer: A Surgical Strategy Debate

Document Type : Original Article

Authors

1 Innovative Medical Research Center, MMS.C., Islamic Azad University, Mashhad, Iran

2 Endoscopic and Minimally Invasive Surgery Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Endoscopic and Minimally Invasive Surgery Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

4 Department of General Surgery, MMS.C., Islamic Azad University, Mashhad, Iran

Abstract

Background: Although Abdominoperineal Resection (APR) rates have declined over the last fifty years, it remains the best treatment option in many circumstances.
 
Objectives: This study aimed to investigate the short-term outcomes of two-stage versus three-stage laparoscopic abdominoperineal resection in rectal cancer.
 
Methods: This retrospective cohort study included 113 patients with rectal cancer eligible for laparoscopic APR at Razavi Hospital in Mashhad from 2020 to 2023. Inclusion criteria were age over 18 and a confirmed diagnosis via pathology, while exclusion criteria included recurrent rectal cancer, anal canal, and rectosigmoidal tumors, tumors located more than 15 centimeters from the anal verge, and concurrent colonic lesions. Data analysis was conducted using R software and SPSS.
 
Results: The study included 42 patients undergoing a two-step surgical technique and 71 patients with a three-step technique. Results showed that the two-step group had a longer mean hospital stay (9.48 ± 4.09 days) than the three-step group (7.63 ± 1.30 days; p = 0.002). Surgical site infections occurred in 15.6% of the two-step patients, whereas none occurred in the three-step group (p=0.020). The mean surgery duration was also longer in the two-step group (222.18±56.08 minutes) than in the three-step group (170.78±29.13 minutes; p=0.00). Revision surgery was required in 23.8% of the two-stage group, compared with 4.2% in the three-stage group (p=0.002). Blood transfusion rates were similar: 23.8% in the two-step group and 22.5% in the three-step group (p=0.876).
 
Conclusion: The three-stage approach to APR may improve surgical outcomes. However, larger prospective studies are needed to confirm these findings.

Keywords

Acknowledgements: The authors would like to express their gratitude to all participants in this study. We also appreciate the support from Islamic Azad University, Mashhad Medical Sciences Unit, for facilitating this research.

 

Availability of data and materials: The data supporting the findings of this study are available from the corresponding author upon reasonable request.

 

Conflicts of interests: The authors declare no conflicts of interest.

 

Consent for publication: Not applicable.

 

Ethics approval and consent to participate: This study received ethical approval from the Mashhad University of Medical Sciences Ethics Committee (ID: IR.MUMS.REC.1402.021). All procedures were conducted in accordance with the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its later amendments. Written informed consent was obtained from all individual participants included in the study.

 

Financial disclosure: This research received no funding.

 

Author contributions: Conceptualization: A.A., Methodology and Formal analysis: A.M., Investigation, Data curation: A.A., R.R., S.H., and T.Z., Writing- Original draft: S.H. and T.Z., Writing - review & editing: R.R., A.A., and T.Z.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

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Razavi Journal of Medicine
Volume 14, Issue 1
January 2026
Pages 14-21

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