title: Long-term outcome of extralevator abdominoperineal excision (ELAPE) for low rectal cancer.
abstract: OBJECTIVE
  Extralevator abdominoperineal excision (ELAPE) was introduced to improve outcomes for low-lying locally advanced rectal cancers (LARC) not amenable to sphincter preserving procedures. This study investigates prospectively outcomes of patients operated on with ELAPE compared with a similar cohort of patients operated on with conventional APE.
  
  
  METHODS
  After the exclusion of patients without neoadjuvant therapy, in-hospital mortality, and incomplete metastatectomy, we identified 72 consecutive patients who had undergone either conventional APE (n = 36) or ELAPE (n = 36) for LARC ≤6 cm from the anal verge. The primary outcome measure was local recurrence at 5 years, and secondary outcome measures were cause-specific and overall survival.
  
  
  RESULTS
  Median distance from the anal verge was significantly lower in the ELAPE group (2 vs. 4 cm, p = 0.029). Inadvertent bowel perforation could be completely avoided in the ELAPE group, but amounted to 16.7 % in the conventional APE group (p = 0.025). Cumulative local recurrence rate at 5 years was 18.2 % in the APE group compared to 5.9 % in the ELAPE group (p = 0.153). Local recurrence without distant metastases occurred in 15.5 % in the APE group but was not observed in the ELAPE group (p = 0.039). We did not detect significant differences in cause-specific nor in overall survival.
  
  
  CONCLUSIONS
  ELAPE results in lower local recurrence rates as compared with conventional APE. We conclude that the extralevator approach should be the procedure of choice for advanced low rectal cancer not amenable to sphincter preserving procedures.
authors.affiliation: Department of General and Visceral Surgery, Dresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of Dresden, Friedrichstr. 41, D-01067, Dresden, Germany. stelzner-si@khdf.de.
authors.forename: Sigmar
authors.initials: S
authors.lastname: Stelzner
authors.affiliation: Department of General and Visceral Surgery, Dresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of Dresden, Friedrichstr. 41, D-01067, Dresden, Germany.
authors.forename: Gunter
authors.initials: G
authors.lastname: Hellmich
authors.affiliation: Department of General and Visceral Surgery, Dresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of Dresden, Friedrichstr. 41, D-01067, Dresden, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Sims
authors.affiliation: Department of Radiology, Dresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of Dresden, Friedrichstr. 41, D-01067, Dresden, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kittner
authors.affiliation: Institute of Pathology, Dresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of Dresden, Friedrichstr. 41, D-01067, Dresden, Germany.
authors.forename: Eric
authors.initials: E
authors.lastname: Puffer
authors.affiliation: Department of Radiation Oncology, Dresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of Dresden, Friedrichstr. 41, D-01067, Dresden, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Zimmer
authors.affiliation: Department of Oncology, Dresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of Dresden, Friedrichstr. 41, D-01067, Dresden, Germany.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Bleyl
authors.affiliation: Department of General and Visceral Surgery, Dresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of Dresden, Friedrichstr. 41, D-01067, Dresden, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Witzigmann
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D012004:Rectal Neoplasms / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Abdominoperineal excision; Extralevator; Local recurrence; Rectal cancer; Surgery; Survival