title: Application of laparoscopic extralevator abdominoperineal excision in locally advanced low rectal cancer.
abstract: BACKGROUND
  When compared with conventional abdominoperineal resection (APR), extralevator abdominoperineal excision (ELAPE) has been demonstrated to reduce the risk of local recurrence for the treatment of locally advanced low rectal cancer. Combined with the laparoscopic technique, laparoscopic ELAPE (LELAPE) has the potential to reduce invasion and hasten postoperative recovery. In this study, we aim to investigate the advantages of LELAPE in comparison with conventional APR.
  
  
  METHODS
  From October 2010 to February 2013, 23 patients with low rectal cancer (T 3-4 N 0-2 M 0 ) underwent LELAPE; while during the same period, 25 patients were treated with conventional APR. The patient characteristics, intraoperative data, postoperative complications, and follow-up results were retrospectively compared and analyzed.
  
  
  RESULTS
  The basic patient characteristics were similar; but the total operative time for the LELAPE was longer than that of the conventional APR group (P = 0.014). However, the operative time for the perineal portion was comparable between the two groups (P = 0.328). The LELAPE group had less intraoperative blood loss (P = 0.022), a lower bowel perforation rate (P = 0.023), and a positive circumferential margin (P = 0.028). Moreover, the patients, who received the LELAPE, had a lower postoperative Visual Analog Scale, quicker recovery of bowel function (P = 0.001), and a shorter hospital stay (P = 0.047). However, patients in the LELAPE group suffered more chronic perineal pain (P = 0.002), which may be related to the coccygectomy (P = 0.033). Although the metastasis rate and mortality rate were similar between the two groups, the local recurrence rate of the LELAPE group was statistically improved (P = 0.047).
  
  
  CONCLUSIONS
  When compared with conventional APR, LELAPE has the potential to reduce the risk of local recurrence, and decreases operative invasion for the treatment of locally advanced low rectal cancer.
authors.forename: Yan-Lei
authors.initials: YL
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Dai
authors.forename: Jin-Bo
authors.initials: JB
authors.lastname: Jiang
authors.forename: Hui-Yang
authors.initials: HY
authors.lastname: Yuan
authors.forename: San-Yuan
authors.initials: SY
authors.lastname: Hu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome