Abdominoperineal resection for rectal cancer was developed at the beginning of the twentieth century. The operation removes the tumor-bearing segment, the anus, and lymphatic routes of spread upwards along the superior rectal vessels, laterally along the middle rectal vessels and inferiorly. The operation results in a permanent colostomy. Surgery is divided into two parts. The abdominal portion involves the mobilization of the rectosigmoid colon and its mesenteries down to the pelvic floor. The perineal portion mobilizes the anus from the pelvic floor and perianal soft tissue.