Anesthetic Management for Miles’ Operation (Abdominoperineal resection) in a Patient with Rectal Cancer : a Case Report

Abstract

Distal rectal cancer involving the anal sphincter may require abdominoperineal resection (APR), also known as Miles’ operation. This major surgical procedure requires optimal anesthetic management to maintain hemodynamic stability and minimize perioperative complications. This case report describes the anesthetic management of a patient with rectal cancer undergoing Miles’ operation. A 52-year-old woman with a one-year history of bloody bowel movements and weight loss underwent Miles’ operation following colostomy and four cycles of chemotherapy. Preoperative evaluation revealed stable hemodynamic status, a hemoglobin level of 11.9 g/dL, albumin level of 3.74 g/dL, and normal renal and hepatic function. General anesthesia with endotracheal intubation was induced using fentanyl, propofol, and atracurium, followed by maintenance with sevoflurane, continuous propofol infusion, and continuous atracurium infusion. The operation lasted 2.5 hours, with estimated blood loss of 800 mL and urine output of 500 mL. Intraoperative fluid management included crystalloids, colloids, and 200 mL of packed red blood cells (PRC), administered based on the clinical judgment of the anesthesia and surgical teams. Vital signs were reported as stable in the anesthesia record, although quantitative data were unavailable. Postoperatively, the patient received antibiotics, analgesics, intravenous fluids, and oral nutrition during a two-day hospital stay. She reported pain around the surgical wound but experienced no significant complications and was discharged in good condition. This case highlights the importance of comprehensive preoperative assessment, appropriate anesthetic selection, intraoperative monitoring, and fluid and blood loss management in supporting recovery following major surgery.