Extralevator abdominoperineal excision versus conventional surgery for low rectal cancer: a single surgeon experience.
OBJECTIVE
Extralevator abdominoperineal excision (ELAPE) reduces the risk of positive circumferential resection margin (CRM) and of intraoperative perforation (IOP), both of which are associated with high local recurrence rates and poor survival outcomes for rectal cancer. The aim of this study was to compare the results of ELAPE with conventional abdominoperineal excision (APE) for low rectal cancer.


METHODS
A total of 25 consecutive patients underwent ELAPE for low rectal cancer between November 2008 and September 2011. Fifty-six patients treated by conventional APE prior to 2008 were selected from our rectal cancer database for comparison as a historical cohort.


RESULTS
The mean follow-up was 44.7 months in the ELAPE group, and 70.6 months in the APE group. Patients undergoing ELAPE had a lower CRM positivity and IOP rate than APE (12% vs. 20%, p=0,531; 4% vs. 8,9%, p=0,826; respectively). The ELAPE group was associated with higher perineal wound complications than the APE group (16.0% vs. 1.8%, p=0.030). Local recurrence rates for patients in both groups did not differ significantly (4.0% vs. 3.6%, p=1.0).


CONCLUSIONS
The results of this study suggest that ELAPE technique was associated with less CRM involvement and reduced rates of IOP but markedly higher rates of postoperative perineal complications occurred as compared to conventional surgery. ELAPE must be reserved for advanced low rectal cancers.
Clinic of Gastrointestinal Surgery, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey.
Gürel
G
Neşşar
Clinic of Gastrointestinal Surgery, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey.
Ali Eba
AE
Demirbağ
Department of General Surgery, Kocatepe University School of Medicine, Afyon, Turkey.
Bahadır
B
Celep
Clinic of Gastrointestinal Surgery, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey.
Orhan Hayri
OH
Elbir
Department of Gastrointestinal Surgery, İnönü University Turgut Özal Medical Center, Malatya, Turkey.
Cüneyt
C
Kayaalp
Extralevator abdominoperineal excision; margin involvement; perforation; rectal cancer