Extralevator vs conventional abdominoperineal resection for rectal cancer-A systematic review and meta-analysis.
BACKGROUND
The aim of this study was to compare the short-term morbidity and long-term oncologic benefits of extralevator abdominoperineal excision (ELAPE) with conventional abdominoperineal resection (CAPR) for patients with rectal cancer.


METHODS
Electronic search of the Cochrane Library, MEDLINE, EMBASE, Korean Journal, and J-EAST database from 2007 until August 2015 was carried out. We considered randomized controlled trials and nonrandomized comparative studies comparing ELAPE with CAPR to be eligible, if they included patients with rectal cancers.


RESULTS
A total of 1 randomized controlled trials and 10 nonrandomized comparative studies met the inclusion criteria, involving 1,736 patients in the ELAPE group and 1,320 in the CAPR group. The ELAPE was associated with a significantly lower intraoperative perforation rate. There were no differences regarding the circumferential margin involvement, R0 resections, and local recurrence rate. There was less blood loss in ELAPE patients.


CONCLUSIONS
The ELAPE significantly lowered the intraoperative perforation rate, with no benefits regarding circumferential resection margin involvement and local recurrence rate.
General Surgery Department, Carol Davila University of Medicine and Pharmacy Bucharest, No. 37 Dionisie Lupu Street, Sector 2, 020021, Bucharest, Romania; General Surgery Department, Emergency Hospital of Bucharest, Bucharest, Romania. Electronic address: negoiionut@gmail.com.
Ionut
I
Negoi
General Surgery Department, Carol Davila University of Medicine and Pharmacy Bucharest, No. 37 Dionisie Lupu Street, Sector 2, 020021, Bucharest, Romania; National Institute of Legal Medicine Mina Minovici, Bucharest, Romania.
Sorin
S
Hostiuc
General Surgery Department, Carol Davila University of Medicine and Pharmacy Bucharest, No. 37 Dionisie Lupu Street, Sector 2, 020021, Bucharest, Romania; General Surgery Department, Emergency Hospital of Bucharest, Bucharest, Romania.
Sorin
S
Paun
Anatomy Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
Ruxandra I
RI
Negoi
General Surgery Department, Carol Davila University of Medicine and Pharmacy Bucharest, No. 37 Dionisie Lupu Street, Sector 2, 020021, Bucharest, Romania; General Surgery Department, Emergency Hospital of Bucharest, Bucharest, Romania.
Mircea
M
Beuran
D000005:Abdomen / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D006801:Humans; D010502:Perineum / Q000601:surgery*; D012004:Rectal Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
Conventional abdominoperineal resection; Extralevator abdominoperineal resection; Meta-analysis; Rectal cancer