A prospective multicenter clinical study of extralevator abdominoperineal resection for locally advanced low rectal cancer.
BACKGROUND
Recent studies have shown that extralevator abdominoperineal resection has the potential for reduced circumferential resection margin involvement, intraoperative bowl perforation, and local recurrence rates; however, it has been suggested that extended resection may be associated with increased morbidity because of the formation of a larger perineal defect.


OBJECTIVE
This study was undertaken to demonstrate the feasibility and complications of extralevator abdominoperineal resection for locally advanced low rectal cancer in China.


METHODS
This was a prospective cohort study.


METHODS
The study was conducted at 7 university hospitals throughout China.


METHODS
A total of 102 patients underwent this procedure for primary locally advanced low rectal cancer between August 2008 and October 2011.


METHODS
The main outcome measures comprised circumferential resection margin involvement, intraoperative perforation, postoperative complications, and local recurrence.


RESULTS
The most common complications included sexual dysfunction (40.5%), perineal complications (23.5%), urinary retention (18.6%), and chronic perineal pain (13.7%). Chronic perineal pain was associated with coccygectomy (p < 0.001), and the pain gradually eased over time. Reconstruction of the pelvic floor with biological mesh was associated with a lower rate of perineal dehiscence (p = 0.006) and overall perineal wound complications (p = 0.02) in comparison with primary closure. A positive circumferential margin was demonstrated in 6 (5.9%) patients, and intraoperative perforations occurred in 4 (3.9%) patients. All circumferential margin involvements and intraoperative perforations were located anteriorly. The local recurrence was 4.9% at a median follow-up of 44 months (range, 18-68 months).


CONCLUSIONS
This was a nonrandomized, uncontrolled study.


CONCLUSIONS
Extralevator abdominoperineal resection performed in the prone position for low rectal cancer is a relatively safe approach with acceptable circumferential resection margin involvement, intraoperative perforations, and local recurrences. Reconstruction of the pelvic floor with biological mesh might lower the rate of perineal wound complications (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A161).
1Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China 2Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China 3Department of General Surgery, Qilu Hospital of Shandong University, Shandong, People's Republic of China 4Department of General Surgery, the First Hospital of Huairou District, Beijing, People's Republic of China 5Department of General Surgery, the People's Hospital of Daxing District, Beijing, People's Republic of China 6Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China 7Department of General Surgery, Luhe Teaching Hospital, Capital Medical University, Beijing, People's Republic of China.
Jia Gang
JG
Han
Zhen Jun
ZJ
Wang
Qun
Q
Qian
Yong
Y
Dai
Zhi Quan
ZQ
Zhang
Jin Shan
JS
Yang
Fei
F
Li
Xiao Bin
XB
Li
D000005:Abdomen / Q000601:surgery; D001706:Biopsy; D002681:China; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis / Q000453:epidemiology; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D017773:Pelvic Floor / Q000601:surgery; D010502:Perineum / Q000601:surgery; D011183:Postoperative Complications / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery; D012007:Rectum / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome