title: Circumferential resection margins and perineal complications after neoadjuvant long-course chemoradiotherapy followed by extralevator abdominoperineal excision of the rectum: Five years of activity at a single institution.
abstract: BACKGROUND
  Prone extralevator abdominoperineal excision of the rectum (ELAPE) has been introduced to improve the circumferential resection margins (CRM) compared with traditional APER.
  
  
  OBJECTIVE
  We present short-term results achieved with prone ELAPE preceded by neoadjuvant chemoradiotherapy during the last 5 years of activity.
  
  
  METHODS
  A retrospective review was conducted.
  
  
  METHODS
  Prone ELAPE operations performed between September 2010 and August 2014 at Leicester Royal Infirmary preceded by neoadjuvant chemoradiotherapy.
  
  
  METHODS
  Data regarding demographics, staging, neoadjuvant therapies, intraoperative perforations, and perineal complications were collected.
  
  
  RESULTS
  Seventy-two patients were included. Pretreatment radiological T4 were 25.0%, histological T4 2.8%. Intraoperative perforations occurred in 2.8%, CRM was involved in 11.1%. Perineal complications consisted of superficial wound infections (20.8%), full thickness dehiscences (16.7%), hematomas (9.7%), pelvic collections (6.9%), and perineal hernias (5.6%).
  
  
  CONCLUSIONS
  In our experience, prone ELAPE preceded by long-course chemoradiotherapy has been successfully used in the last 5 years to resect low rectal tumors. Perineal wound complications rates are similar to those presented in series using direct perineal closures. J. Surg. Oncol. 2016;114:86-90. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Colorectal Surgery, Leicester Royal Infirmary, Leicester, United Kingdom.
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Gravante
authors.affiliation: Department of Colorectal Surgery, Leicester Royal Infirmary, Leicester, United Kingdom.
authors.forename: Anur
authors.initials: A
authors.lastname: Miah
authors.affiliation: Department of Colorectal Surgery, Leicester General Hospital, Leicester, United Kingdom.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Mann
authors.affiliation: Department of Radiology, Leicester Royal Infirmary, Leicester, United Kingdom.
authors.forename: James Andrews
authors.initials: JA
authors.lastname: Stephenson
authors.affiliation: Department of Colorectal Surgery, Leicester Royal Infirmary, Leicester, United Kingdom.
authors.forename: Mohamed Akil Dilawar
authors.initials: MA
authors.lastname: Gani
authors.affiliation: Department of Colorectal Surgery, Leicester Royal Infirmary, Leicester, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Sharpe
authors.affiliation: Department of Colorectal Surgery, Leicester Royal Infirmary, Leicester, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Norwood
authors.affiliation: Department of Colorectal Surgery, Leicester Royal Infirmary, Leicester, United Kingdom.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Boyle
authors.affiliation: Department of Colorectal Surgery, Leicester Royal Infirmary, Leicester, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Miller
authors.affiliation: Department of Colorectal Surgery, Leicester Royal Infirmary, Leicester, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Hemingway
mesh_terms: D000005:Abdomen / Q000601:surgery; D000230:Adenocarcinoma / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010502:Perineum / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D012004:Rectal Neoplasms / Q000628:therapy*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: circumferential margin; extralevator abdominoperineal resection; long-course chemoradiotherapy