Document Detail

Outcome of extralevator abdominoperineal excision compared with standard surgery: results from a single centre.
MedLine Citation:
PMID:  22221401     Owner:  NLM     Status:  MEDLINE    
AIM: Extralevator abdominoperineal excision (APE) for low rectal tumours has been introduced to achieve improved local radicality. Fewer positive margins and intraoperative perforations have been reported compared with standard APE. The aim of this retrospective study was to compare short-term complications and results of the two techniques in our institution.
METHOD: Consecutive patients with rectal cancer undergoing APE between 2004 and 2009 were included. They were divided into two groups of 79 patients in extralevator APE and 79 in standard APE. Patients with recurrence and those having a palliative procedure were excluded. Data were collected from hospital records and the colorectal cancer registry. Main endpoints were wound infection, perineal wound revision, oncological data and length of hospital stay.
RESULTS: Circumferential resection margin positivity did not differ significantly between groups (17% extralevator APE; 20% standard APE). Intraoperative perforation (13%vs 10%) or local recurrence (seven in each group) were no different. Perineal wound infection was more common after extralevator APE (46%vs 28%, P<0.05) as was perineal wound revision (22%vs 8%, P<0.05). Hospital stay was longer after extralevator APE (median 12 vs 11days, P<0.05). Tumour height (median 4cm) and pTNM classification did not differ.
CONCLUSION: The results do not show any advantage for extralevator APE. The oncological data were no better and postoperative morbidity was increased. Further studies are needed before extralevator APE is widely adopted in clinical practice.
D Asplund; E Haglind; E Angenete
Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland     Volume:  14     ISSN:  1463-1318     ISO Abbreviation:  Colorectal Dis     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-09-12     Completed Date:  2013-02-04     Revised Date:  2013-06-07    
Medline Journal Info:
Nlm Unique ID:  100883611     Medline TA:  Colorectal Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  1191-6     Citation Subset:  IM    
Copyright Information:
© 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.
Department of Surgery, Sahlgrenska University Hospital/Östra, University of Gothenburg, Gothenburg, Sweden.
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MeSH Terms
Abdomen / surgery
Adenocarcinoma / pathology,  surgery*,  therapy
Aged, 80 and over
Digestive System Surgical Procedures / methods*
Intraoperative Complications / epidemiology,  etiology
Length of Stay / statistics & numerical data
Middle Aged
Neoadjuvant Therapy
Neoplasm Staging
Perineum / surgery
Postoperative Complications / epidemiology,  etiology
Rectal Neoplasms / pathology,  surgery*,  therapy
Rectum / surgery*
Retrospective Studies
Treatment Outcome
Comment In:
Colorectal Dis. 2013 May;15(5):627-8   [PMID:  23331668 ]
Colorectal Dis. 2013 May;15(5):628   [PMID:  23617847 ]

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