title: Similar long-term overall and disease-free survival after conventional and extralevator abdominoperineal excision-a nationwide study.
abstract: OBJECTIVE
  The purpose of the present study was to assess, compare, and identify factors of importance for long-term overall (OS) and disease-free (DFS) survival after conventional (cAPE) and extralevator abdominoperineal excision (ELAPE) on a nationwide basis.
  
  
  METHODS
  This was a database study based on data from a nationwide colorectal cancer database. Patients undergoing surgery for rectal cancer in the period January 1, 2009 to August 31, 2012 were examined. Factors of importance for disease-free and overall survival were identified by multivariate Cox regressions.
  
  
  RESULTS
  Five hundred patients were included in the final population. Two hundred seventy-six were operated by ELAPE and 224 by APE. Disease-free and overall survival did not differ between groups (4-year DFS 67 and 66 % after cAPE and ELAPE, respectively, (log-rank p = 0.82); 4-year OS 74 and 77 % after cAPE and ELAPE, respectively, (log-rank p = 0.59)). In Cox regression, the type of procedure did not affect DFS or OS. Factors of importance for DFS included increasing age, ypN-positive disease and neoadjuvant chemoradiation therapy. Factors of importance for OS included increasing age, circumferential resection margin (CRM) positivity, fixation of the tumor, blood transfusion, and increasing American Society of Anesthesiologists (ASA) score.
  
  
  CONCLUSIONS
  In this nationwide study, we did not find any differences in DFS or OS after extralevator versus conventional abdominal perineal excision, and the type of procedure did not affect survival after adjusted analyses.
authors.affiliation: Department of Surgery D 113, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730, Herlev, Denmark. mads.klein@regionh.dk.
authors.forename: Mads
authors.initials: M
authors.lastname: Klein
authors.affiliation: Department C, Blegdamsvej 9, Rigshospitalet, University of Copenhagen, DK-2100, Copenhagen East, Denmark.
authors.forename: Emilie
authors.initials: E
authors.lastname: Colov
authors.affiliation: Zealand University Hospital, University of Copenhagen, Lykkebækvej 1, DK-4600, Køge, Denmark.
authors.forename: Ismail
authors.initials: I
authors.lastname: Gögenur
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D003710:Demography; D013505:Digestive System Surgical Procedures / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000601:surgery*; D010502:Perineum / Q000601:surgery*; D016016:Proportional Hazards Models; D013997:Time Factors
keywords: APE; Abdominoperineal; ELAPE; Extralevator; Rectal cancer