Outcome of extralevator abdominoperineal excision compared with standard surgery: results from a single centre.
OBJECTIVE
Extralevator abdominoperineal excision (APE) for low rectal tumours has been introduced to achieve improved local radicality. Fewer positive margins and intraoperative perforations have been reported compared with standard APE. The aim of this retrospective study was to compare short-term complications and results of the two techniques in our institution.


METHODS
Consecutive patients with rectal cancer undergoing APE between 2004 and 2009 were included. They were divided into two groups of 79 patients in extralevator APE and 79 in standard APE. Patients with recurrence and those having a palliative procedure were excluded. Data were collected from hospital records and the colorectal cancer registry. Main endpoints were wound infection, perineal wound revision, oncological data and length of hospital stay.


RESULTS
Circumferential resection margin positivity did not differ significantly between groups (17% extralevator APE; 20% standard APE). Intraoperative perforation (13%vs 10%) or local recurrence (seven in each group) were no different. Perineal wound infection was more common after extralevator APE (46%vs 28%, P<0.05) as was perineal wound revision (22%vs 8%, P<0.05). Hospital stay was longer after extralevator APE (median 12 vs 11days, P<0.05). Tumour height (median 4cm) and pTNM classification did not differ.


CONCLUSIONS
The results do not show any advantage for extralevator APE. The oncological data were no better and postoperative morbidity was increased. Further studies are needed before extralevator APE is widely adopted in clinical practice.
Department of Surgery, Sahlgrenska University Hospital/Östra, University of Gothenburg, Gothenburg, Sweden. dan.asplund@vgregion.se
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Asplund
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Haglind
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Angenete
D000005:Abdomen / Q000601:surgery; D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010502:Perineum / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome