title: Outcomes after biological mesh reconstruction of the pelvic floor following extra-levator abdominoperineal excision of rectum (APER).
abstract: BACKGROUND
  Extra-levator abdominoperineal excision of the rectum (ELAPER) for low rectal cancer is used to avoid the adverse oncological outcomes of inadvertent perforation and a positive circumferential resection margin associated with the conventional APER technique. This wider excision creates a large defect requiring pelvic floor reconstruction, and there is still controversy regarding the best method of closure. The aim of this study is to present outcomes of biological mesh pelvic floor reconstruction following ELAPER.
  
  
  METHODS
  Prospective data on consecutive patients having ELAPER for low rectal cancer at a single UK institution between October 2008 and March 2013 were collected. The perineum was reconstructed using a biological mesh and the short-term outcomes were evaluated, focusing particularly on perineal wound complications and perineal hernias.
  
  
  RESULTS
  Thirty-four patients were included [median age 62 years, range 40-72 years, 27 males (79 %)]. The median operative time was 248 min (range 120-340 min). The median length of hospital stay was 9 days (range 4-20 days). There were three perineal complications (9 %) requiring surgical intervention, but no meshes were removed. There were no perineal hernias. The median length of follow-up was 21 months (range 1-54 months). The overall mortality was 9 % from distant metastases.
  
  
  CONCLUSIONS
  Our series adds to the increasing evidence that good outcomes can be achieved for pelvic floor reconstruction with biological mesh following ELAPER without the additional use of myocutaneous flaps. The low serious complication rate, good outcomes in perineal wound healing and the absence of perineal hernias demonstrates that this is a safe and feasible procedure.
authors.affiliation: Division of Surgery, School of Graduate Entry Medicine and Health, University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3DT, UK, oliver.peacock@nhs.net.
authors.forename: O
authors.initials: O
authors.lastname: Peacock
authors.forename: J A
authors.initials: JA
authors.lastname: Simpson
authors.forename: S I
authors.initials: SI
authors.lastname: Tou
authors.forename: N G
authors.initials: NG
authors.lastname: Hurst
authors.forename: W J
authors.initials: WJ
authors.lastname: Speake
authors.forename: G M
authors.initials: GM
authors.lastname: Tierney
authors.forename: J N
authors.initials: JN
authors.lastname: Lund
mesh_terms: D000328:Adult; D000368:Aged; D003094:Collagen / Q000627:therapeutic use*; D003952:Diagnostic Imaging; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D061646:Operative Time; D017773:Pelvic Floor / Q000601:surgery*; D010502:Perineum / Q000601:surgery; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D013524:Surgical Flaps; D016896:Treatment Outcome
chemical_list: C588278:surgisis; D003094:Collagen