title: Analysis of outcome using a levator sparing technique of abdominoperineal excision of rectum and anus. Cylindrical ELAPE is not necessary in all patients.
abstract: OBJECTIVE
  Abdominoperineal excision of rectum (APE) for cancer has a higher rate of local recurrence with a poorer outcome than stage matched anterior resection. The cylindrical excision (ELAPE) has been advocated to reduce local recurrence. However, this operation has greater morbidity and requires more post operative care. We report our outcomes from a single centre using a levator sparing dissection.
  
  
  METHODS
  All patients undergoing APE from January 2007-June 2011 were evaluated. Case notes operation notes and pathology results were reviewed for complications and staging. Follow-up data for survival and recurrence were obtained from the cancer registry, imaging and from clinic follow up.
  
  
  RESULTS
  Of all rectal cancers (n = 361), 43 had APE with curative intent. Median age was 67(IQR 59-76). Median tumour height was two centimetres from the dentate line (IQR 1-3.5 cm). Neoadjuvant chemoradiotherapy was given in 98% of APE resections with curative intent. Median post operative hospital stay was 10 days (8-15). At a median follow up of 38 months (IQR30-49) for patients undergoing curative resection, 2 patients (4.6%) had local recurrence and overall mortality was 18.6% (n = 8).
  
  
  CONCLUSIONS
  With adequate neoadjuvant chemoradiotherapy, a levator sparing excision of rectum remains a safe option with less morbidity and perioperative complications than has been described for ELAPE.
authors: Aberdeen Royal Infirmary, Colorectal Department, Aberdeen AB252ZN, United Kingdom. Electronic address: georamsay@gmail.com.
authors: G
authors: G
authors: Ramsay
authors: C
authors: C
authors: Parnaby
authors: C
authors: C
authors: Mackay
authors: P
authors: P
authors: Hanlon
authors: S
authors: S
authors: Ong
authors: M
authors: M
authors: Loudon
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001005:Anus Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments / Q000379:methods*; D010348:Patient Care Team; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012606:Scotland; D016896:Treatment Outcome
keywords: APER; Abdomino-perineal resection; Colorectal; ELAPE; Outcomes