[A prospective multicenter clinical trial of extralevator abdominoperineal excision for locally advanced low rectal cancer].
OBJECTIVE
To demonstrate the feasibility of extralevator abdominoperineal excision (ELAPE) for locally advanced low cancer in China.


METHODS
A prospective multicenter clinical trial was carried out by 7 general hospitals across China from August 2008 to October 2011. A total of 102 patients underwent ELAPE for primary locally advanced low rectal cancer. There were 60 male and 42 female patients. The patients' characteristics, complications and prognosis were recorded.


RESULTS
All patients underwent the ELAPE procedure successfully. The median operating time was 180 minutes (range 110-495 minutes) and median intraoperative blood loss was 200 ml (range 50-1000 ml). The rates of sexual dysfunction, perineal complications, urinary retention, and chronic perineal pain were 40.5%, 23.5%, 18.6% and 13.7%, respectively. Chronic perineal pain was associated with coccygectomy (12 months postoperatively, t = 8.06, P < 0.01), and the pain might gradually ease over time. Reconstruction of pelvic floor with biologic mesh was associated with lower rate of perineal dehiscence (χ(2) = 13.502, P = 0.006) and overall perineal wound complications (χ(2) = 5.836, P = 0.016) compared with primary closure. A positive circumferential margin (CRM) was demonstrated in 6 (5.9%) patients, and intraoperative perforations occurred in 4 (3.9%) patients. All CRM involvement and intraoperative perforation located at anteriorly and anterolaterally. The local recurrence was 4.9% at a median follow-up of 35 months (range, 18-58 months).


CONCLUSIONS
ELAPE performed in the prone position for low rectal cancer leads to a reduction in CRM involvement, intraoperative perforations, and local recurrence, but it might result in a little high rate of perineal wound related complications. Reconstruction of pelvic floor with biologic mesh might lower the rate of perineal wound complications.
Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China. Email: wang3zj@sohu.com.
Zhenjun
Z
Wang
Qun
Q
Qian
Yong
Y
Dai
Zhiquan
Z
Zhang
Jinshan
J
Yang
Fei
F
Li
Xiaobin
X
Li
Jiagang
J
Han
Congqing
C
Jiang
Jinbo
J
Jiang
Baoju
B
Qi
Zuojun
Z
Liu
Zhigang
Z
Gao
Yanfu
Y
Du
Yong
Y
Yang
Guanghui
G
Wei
Hao
H
Qu
Minzhe
M
Li
Huachong
H
Ma
Bingqiang
B
Yi
D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D016896:Treatment Outcome