title: Extralevator abdominoperineal excision for low rectal cancer: a systematic review and meta-analysis of the short-term outcome.
abstract: OBJECTIVE
  The superiority of extralevator abdominoperineal excision (ELAPE) over conventional abdominoperineal excision (APE) remains controversial, despite the publication of many studies on this issue. The aim of this meta-analysis was to provide a clear, evidence-based comparison of the two procedures.
  
  
  METHODS
  A systematic review and meta-analysis was conducted through a comprehensive search of the PubMed, EMBASE/Medline and Cochrane Central Library databases for all studies comparing ELAPE with conventional APE for low rectal cancer. Pooled data on circumferential resection margin (CRM) positivity, intra-operative bowel perforation, perineal wound complications and local recurrence were analysed.
  
  
  RESULTS
  Seven studies, involving a total of 2672 patients, were included. Analysis of the pooled data did not reveal a significant difference between the two operations regarding CRM positivity [risk ratio (RR) = 0.79, 95% CI: 0.40-1.57; P = 0.50, I(2)  = 86%] and perineal wound complications (RR = 0.91, 95% CI: 0.71-1.16; P = 0.44, I(2)  = 49%), and showed a borderline reduced risk of intra-operative bowel perforation for ELAPE, but still did not reveal a significant difference between the two groups (RR = 0.61, 95% CI: 0.37-1.00; P = 0.05, I(2)  = 58%).
  
  
  CONCLUSIONS
  The current evidence does not indicate a statistically significant superiority of ELAPE over conventional APE in terms of CRM positivity and intra-operative bowel perforation.
authors.affiliation: Department of General Surgery, Peking University Third Hospital, Beijing, China.
authors.forename: X
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of General Surgery, Peking University Third Hospital, Beijing, China.
authors.forename: T
authors.initials: T
authors.lastname: Sun
authors.affiliation: Department of General Surgery, Peking University Third Hospital, Beijing, China.
authors.forename: H
authors.initials: H
authors.lastname: Xie
authors.affiliation: Department of General Surgery, Peking University Third Hospital, Beijing, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, Peking University Third Hospital, Beijing, China.
authors.forename: H
authors.initials: H
authors.lastname: Zeng
authors.affiliation: Department of General Surgery, Peking University Third Hospital, Beijing, China.
authors.forename: W
authors.initials: W
authors.lastname: Fu
mesh_terms: D000005:Abdomen / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D006801:Humans; D010502:Perineum / Q000601:surgery*; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D016896:Treatment Outcome
keywords: Extralevator abdominoperineal excision; circumferential resection margin; intra-operative bowel perforation; perineal wound complications; rectal cancer