title: Extralevator abdominoperineal excision (ELAPE) for rectal cancer--short-term results from the Swedish Colorectal Cancer Registry. Selective use of ELAPE warranted.
abstract: OBJECTIVE
  Local recurrences are more common after abdominoperineal excision (APE) than after anterior resection of rectal cancer. Extralevator APE was introduced to address this problem. This prospective registry-based population study aims to investigate the efficacy of extralevator APE (ELAPE) in improving short-term oncological outcome.
  
  
  METHODS
  All Swedish patients operated with any kind of abdominoperineal excision and registered in the Swedish Rectal Cancer Registry 2007-2009 were included (n = 1,397) and analyzed with emphasis on the perineal part of the operation. Short-term perioperative and oncological results were collected from the registry.
  
  
  RESULTS
  Extralevator APE did not result in fewer intraoperative perforations or involved circumferential resection margins as compared to standard APE for the entire group. Intraoperative perforations were significantly fewer for patients with low tumours (≤4 cm) (ELAPE: n = 28/386 versus APE: n = 9/58) (p = 0.043) and for early (T0-T2) T-stages (ELAPE: n = 3/172 versus APE: n = 6/75) (p = 0.025). There were significantly more post-operative wound infections for ELAPE than for APE (n = 106 (20.4 %) versus n = 25 (12.0 %), p = 0.011).
  
  
  CONCLUSIONS
  The short-term results indicate that selective use of extralevator APE can be warranted, for example, for subgroups with low tumours. In conclusion, selective use of the extralevator APE is advocated as not all patients seem to benefit from the technique, and there are significantly more short-term complications after extralevator APE.
authors.affiliation: Department of Surgery, NU Hospital Group, Trollhättan, Sweden, mattias.prytz@vgregion.se.
authors.forename: Mattias
authors.initials: M
authors.lastname: Prytz
authors.forename: Eva
authors.initials: E
authors.lastname: Angenete
authors.forename: Jan
authors.initials: J
authors.lastname: Ekelund
authors.forename: Eva
authors.initials: E
authors.lastname: Haglind
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D015179:Colorectal Neoplasms / Q000601:surgery; D003710:Demography; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D012004:Rectal Neoplasms / Q000601:surgery*; D012042:Registries; D013548:Sweden; D013997:Time Factors