title: Short-term outcomes of the prone perineal approach for extra-levator abdomino-perineal excision (elAPE).
abstract: BACKGROUND
  Many studies report that low rectal cancer treated with abdomino-perineal excision (APE) have higher rates of CRM involvement with associated local recurrence and worse survival when compared to low anterior resection. We present a single surgeon's short-term outcomes using the prone perineal extra-levator (elAPE) approach.
  
  
  METHODS
  Thirty-one patients between 2006 and 2010 underwent elAPE with curative intent. Data was collected prospectively recording patient tumour characteristics and histological outcome. Outcome measures included circumferential resection margins, recurrence rates, 30-day morbidity and mortality.
  
  
  RESULTS
  Mean distance of tumour from anal verge was 3.63 ± SD 1.52 cm. 14 patients had pre-operative chemo-radiotherapy. The involved circumferential resection margin rate was 3.2%. Median follow-up was 20 (0-45) months, with overall mortality of 13.3% and 30 day mortality of 6.6%.
  
  
  CONCLUSIONS
  The prone position elAPE has a low circumferential resection margin involved rate and, through improved vision, reduces the risk of inadvertent tumour or specimen perforation.
authors.affiliation: Dept of Histopathology, Royal Devon & Exeter Hospital, Devon, UK.
authors.forename: R S J
authors.initials: RS
authors.lastname: Dalton
authors.forename: N J
authors.initials: NJ
authors.lastname: Smart
authors.forename: T J
authors.initials: TJ
authors.lastname: Edwards
authors.forename: I
authors.initials: I
authors.lastname: Chandler
authors.forename: I R
authors.initials: IR
authors.lastname: Daniels
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D010502:Perineum / Q000601:surgery*; D016684:Prone Position; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology