title: Short-term outcomes of the modified extralevator abdominoperineal resection for low rectal cancer (with videos).
abstract: BACKGROUND
  Extralevator abdominoperineal resection had oncologic superiority with reduced local recurrence and improving survival rates. However, extended perineal resection resulted in complicated perineal reconstructions. Therefore, a new surgical technique to overcome previous limitations is required. This study aims to demonstrate a surgical procedure and outcomes of the modified extralevator abdominoperineal resection, which satisfies both an extended cylindrical resection and a convenient perineal wound closure by modification of the surgical dissection plane.
  
  
  METHODS
  From September 2011 to February 2014, 12 consecutive patients (five males and seven females) who underwent the modified extralevator abdominoperineal resection for low rectal cancer were evaluated. Intraoperative and postoperative outcomes were assessed. Pathologic outcomes were evaluated for the oncologic results.
  
  
  RESULTS
  The mean age was 55.3 ± 15.1 years, and body mass index was 21.8 ± 3.1 kg/m(2). Ten patients (83.3%) received preoperative chemoradiotherapy. The operations were performed by five cases of laparoscopic surgery, six cases of open surgery and one case of robotic surgery. The mean operation time was 258.8 ± 58.0 min. There were no conversions and no tumor perforations. Days to first soft diet was 4.7 ± 3.4 days, and the mean hospital stay was 11.2 ± 4.7 days. Postoperative complications were two cases of grade I, two cases of grade II and one case of grade III. There was one patient (8.3%) with a positive circumferential resection margin, and there was one case of local recurrence.
  
  
  CONCLUSIONS
  The modified extralevator abdominoperineal resection was feasible and safe for patients with low rectal cancer with extended perineal dissection and convenient direct wound closure.
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Park
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea. whitenoja@yuhs.ac.
authors.forename: Seung Hyuk
authors.initials: SH
authors.lastname: Baik
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Jeonghyun
authors.initials: J
authors.lastname: Kang
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Hyuk
authors.initials: H
authors.lastname: Hur
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Byung Soh
authors.initials: BS
authors.lastname: Min
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Kang Young
authors.initials: KY
authors.lastname: Lee
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Nam Kyu
authors.initials: NK
authors.lastname: Kim
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Seung-Kook
authors.initials: SK
authors.lastname: Sohn
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D004210:Dissection; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010502:Perineum / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: Abdominoperineal resection; Primary closure; Reconstruction; Rectal cancer; Total mesorectal excision