title: Laparoscopic Extralevator Abdominoperineal Excision of the Rectum with Primary Suturing: Short-Term Outcomes from Single-Institution Study.
abstract: OBJECTIVE
  This study evaluated the safety, feasibility, and short-term outcomes of laparoscopic extralevator abdominoperineal excision (laparoscopic-ELAPE) with primary suturing for low rectal cancer.
  
  
  METHODS
  Consecutive patients who underwent laparoscopic-ELAPE with primary suturing for low rectal cancer at our institution between September 2013 and January 2015 were retrospectively identified from a prospectively maintained database. Short-term outcomes, including intraoperative complications, postoperative morbidity, and oncologic adequacy of surgical specimens, were evaluated.
  
  
  RESULTS
  Laparoscopic-ELAPE was successful in all 33 included patients, with no patient requiring conversion to an open approach. Mean operation time was 200 minutes, and mean intraoperative blood loss was 90 mL. Except for bowel perforation in 2 patients (6.1%), there were no intraoperative complications. Two patients (6.1%) had positive circumferential resection margins. Median length of hospital stay was 7 days. The 30-day morbidity and mortality rates were 15.2% and 0%, respectively. Postoperative complications within 30 postoperative days included perineal wound infection (2 patients, 6.1%), respiratory infection (2 patients, 6.1%), and chylous fistula (1 patient, 3.0%). Complications at a median follow-up time of 12 months (range, 3-19 months) included local tumor recurrence (1 patient, 3.0%), perineal dehiscence (2 patients, 6.1%), perineal seroma (1 patient, 3.0%), bowel obstruction (1 patient, 3.0%), urinary retention (2 patients, 6.1%), and chronic perineal pain (2 patients, 6.1%). There were no instances of perineal hernia, persistent sinus, or peristomal hernia.
  
  
  CONCLUSIONS
  Laparoscopic-ELAPE with primary suturing appears to be a feasible and safe treatment approach for low rectal cancer, with acceptable short-term outcomes.
authors.affiliation: 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, Sichuan Province, China .
authors.forename: Xuyang
authors.initials: X
authors.lastname: Yang
authors.affiliation: 2 Department of Gastrointestinal Surgery, The Fifth People's Hospital of Chengdu , Chengdu, Sichuan Province, China .
authors.forename: Chengwu
authors.initials: C
authors.lastname: Jin
authors.affiliation: 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, Sichuan Province, China .
authors.forename: Xiangbing
authors.initials: X
authors.lastname: Deng
authors.affiliation: 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, Sichuan Province, China .
authors.forename: Meng
authors.initials: M
authors.lastname: Wang
authors.affiliation: 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, Sichuan Province, China .
authors.forename: Yuanchuan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, Sichuan Province, China .
authors.forename: Mingtian
authors.initials: M
authors.lastname: Wei
authors.affiliation: 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, Sichuan Province, China .
authors.forename: Wenjian
authors.initials: W
authors.lastname: Meng
authors.affiliation: 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, Sichuan Province, China .
authors.forename: Ziqiang
authors.initials: Z
authors.lastname: Wang
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome