A comparative study of standard versus extralevator abdominoperineal resections

Authors

  • Masimba Nyandowe Department of Surgery, The Townsville Hospital, Townsville, Queensland, Australia
  • Alfred Egedovo Surgical Research Fellow, James Cook University, Townsville, Queensland, Australia
  • Yik-Hong Ho Department of Surgery, The Townsville Hospital, Townsville, Queensland, Australia

DOI:

https://doi.org/10.18203/2349-2902.isj20170921

Keywords:

Abdominoperineal resection, Extralevator abdominoperineal resections, Outcomes

Abstract

Background: The aim was to compare short term outcomes between patients undergoing standard abdominoperineal resection (APR) with those that had an extralevator abdominoperineal excision (ELAPE).

Methods: A retrospective study was done on 123 consecutive patients who underwent an abdominoperineal resection for low rectal cancer at the Townsville hospital between August 2003 and January 2015. Data was collected from medical records.  Short term oncological outcomes were compared between the APR and ELAPE group.

Results: The circumferential resection margin (CRM) involvement rate was significantly lower in the ELAPE group 13.2% versus 19.3% in the APR group. The local recurrence rates in the two groups were not significantly different: 16.8% in the ELAPE versus 17.4% in the APR group. Intraoperative perforations were lower in the ELAPE group 15.3% versus 23.2 % in the APR group. The post-operative wound infection rate was however higher in the ELAPE group 20.3% versus 12.4 % in the APR group.

Conclusions: ELAPE was shown to be superior in the CRM and intraoperative perforation rate but the local recurrence rates were similar. ELAPE had a higher wound complication rate than APR.

Author Biographies

Masimba Nyandowe, Department of Surgery, The Townsville Hospital, Townsville, Queensland, Australia

Surgical registrar

Alfred Egedovo, Surgical Research Fellow, James Cook University, Townsville, Queensland, Australia

Surgical research fellow

Yik-Hong Ho, Department of Surgery, The Townsville Hospital, Townsville, Queensland, Australia

Professor of surgery

References

Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2016:2015-310912.

Mauvais F, Sabbagh C, Brehant O, Viart L, Benhaim T, Fuks D, Regimbeau JM. The current abdominoperineal resection: oncological problems and surgical modifications for low rectal cancer. J Visceral Surg. 2011;148(2):85-93.

Prytz M, Angenete E, Ekelund J, Haglind E. Extralevator abdominoperineal excision (ELAPE) for rectal cancer short-term results from the Swedish colorectal cancer registry. Selective use of ELAPE warranted. Int J Colorectal Dis. 2014;29(8):981-7.

Park S, Hur H, Min BS, Kim NK. Short-term outcomes of an extralevator abdominoperineal resection in the prone position compared with a conventional abdominoperineal resection for advanced low rectal cancer: the early experience at a single institution. Ann Coloproctol. 2016;32(1):12-9.

Stelzner S, Holm T, Moran BJ, Heald RJ, Witzigmann H, Zorenkov D, Wedel T. Deep pelvic anatomy revisited for a description of crucial steps in extralevator abdominoperineal excision for rectal cancer. Diseases Colon Rectum. 2011;54(8):947-57.

Singh B, Lloyd G, Nilsson P, Chaudhri S. Laparoscopic extralevator abdominal perineal excision of the rectum: the best of both worlds. Techniques Coloproctology. 2012;16(1):73-5.

Zhao XT, Yin WB, Lu Y. Comparison of extralevator abdominoperineal excision (ELAPE) and abdominal-perineal resection (APR). Int J Sci. 2016;5:107-12.

Ramsay G, Parnaby C, Mackay C, Hanlon P, Ong S, Loudon M. Analysis of outcome using a levator sparing technique of abdominoperineal excision of rectum and anus. Cylindrical ELAPE is not necessary in all patients. European J Surg Oncol. 2013;39(11):1219-24.

Mann C, Bown E, Couch D, Bhandari S, Boyle K. PWE-300 perineal wound complications in the era of extralevator abdominoperineal excision of the rectum (elape). Gut. 2015;64(1):343-5.

Kang J, Kim H, Hur H, Min BS, Baik SH, Lee KY, Kim NK. Circumferential resection margin involvement in stage III rectal cancer patients treated with curative resection followed by chemoradiotherapy: a surrogate marker for local recurrence? Yonsei Med Journal. 2013;54(1):131-8.

Harris G, Church J, Senagore A, Lavery I, Hull T, Strong S, Fazio V. Factors affecting local recurrence of colonic adenocarcinoma. Diseases Colon Rectum. 2002;45(8):1029-34.

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Published

2017-03-25

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Original Research Articles