A comparative study of standard versus extralevator abdominoperineal resections

Nyandowe, Masimba; Egedovo, Alfred; Ho, Yik‐Hong

doi:10.18203/2349-2902.isj20170921

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…Perineal wound site adverse events also differ in the studies with wide range of the reported rates, from 8.3% to 37% for ELAPE and from 12.3% to 37.1% for standard APE [18][19][20][21]. This study reports one perineal wound break-down in the ELAPE group and no statistical differences in perineal wound infection rates in the groups.…”

Section: Discussionmentioning

confidence: 65%

Extralevator Abdominoperineal Excision (ELAPE) is Not Superior to Abdominoperineal Excision (APE) in the Era of Neoadjuvant Treatment in Rectal Cancer

Ulusoy¹,

Nikolovski

2022

Prilozi

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Aim: To evaluate the effect of extralevator abdominoperineal excision of the rectum (ELAPE) on the circumferential resection margin (CRM) and overall survival in comparison to standard abdominoperineal excision of the rectum (APE) in patients with advanced rectal cancer. Material and Methods: This retrospective study encompasses patients with advanced rectal cancer operated on with two different methods: prone Jack-Knife position ELAPE and APE. In part of them, neoadjuvant chemoradiation was conducted. Postoperative patient, tumor, and outcome data were analyzed in terms of differences in CRM positivity and overall survival. Results: Of 67 patients treated with either APE (52) or ELAPE (15), 43 were male and 24 were female. Neoadjuvant treatment was conducted on 49 of the total patients. Complete pathological response (T0) was achieved in 3 patients. Positive CRM was reported in 7 patients (11.5 %), 3 in ELAPE and 4 in APE group (p = 0.348). The overall postoperative complication rate was 56.7%. Mean survival period was 42.2 months. Overall survival rate for both groups was 67.2 %. No statistical differences were seen between the ELAPE and APE procedure in terms of overall survival (p = 0.483). Conclusions: Differences between the use of ELAPE and APE in terms of CRM positivity and overall survival were not statistically significant. Therefore, we conclude that ELAPE is not superior to standard APE in the treatment of advanced rectal cancer.

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Section: Discussionmentioning

confidence: 65%

Extralevator Abdominoperineal Excision (ELAPE) is Not Superior to Abdominoperineal Excision (APE) in the Era of Neoadjuvant Treatment in Rectal Cancer

Ulusoy¹,

Nikolovski

2022

Prilozi

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“…However, compared with APR, ELAPE increases the resection involvement of the pelvic floor muscles and surrounding tissues of the rectum, which results in larger defects and dead spaces, and further increases the risk of perineal wound complications. 4 , 7 It had been reported that the perineal wound complications were increased (range from 20% to 38%) after ELAPE. 8 , 9 A latest study reported that the rates of SSI after ELAPE was 26.3%.…”

Section: Introductionmentioning

confidence: 99%

Continuous Negative Pressure Drainage with Intermittent Irrigation Leaded to a Risk Reduction of Perineal Surgical Site Infection Following Laparoscopic Extralevator Abdominoperineal Excision for Low Rectal Cancer

Han

Yang

Wang

et al. 2021

TCRM

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Purpose High rate of perineal surgical site infection (SSI) is the most common complication following abdominoperineal resection (APR), especially for extralevator abdominoperineal excision (ELAPE). The purpose of this study was to investigate the effect of continuous negative pressure drainage combined with intermittent irrigation (CNPDCII) in the presacral space on the perineal SSI following laparoscopic ELAPE for low rectal cancer. Patients and Methods The clinical data of 99 patients with low rectal cancer who underwent laparoscopic ELAPE surgery were retrospectively analyzed. Among the 99 patients, 46 patients received CNPDCII and 53 patients received conventional drainage in the presacral space after ELAPE. Self-made irrigation drainage tube: took a silicone drainage tube, cut 3 side holes at every 2cm intervals at the front end, and fixed a flexible tube of an intravenous needle at the front end of the silicone drainage tube. The conventional drainage tube or self-made irrigation drainage tube was placed in the presacral space and poked out from the inside of the ischial tuberosity. The incidence of SSI and other perioperative indicators between the two groups was compared within 30 days after surgery. Results There was no statistical difference in clinicopathological features between the two groups of patients (p>0.05). A statistically lower rate of SSI was found in CNPDCII group (17.4%, 8/46) than the conventional drainage group (35.8%, 19/53). The drainage tube retention time (7.8±1.2 d VS 9.4±1.6 d) and the postoperative hospital stay (9.7±1.4 d VS 11.9±2.3 d) in CNPDCII group were significantly shortened than the conventional drainage group. There was no statistical difference in operating theatre time and intraoperative blood loss between the two groups. Multivariate analysis confirmed that CNPDCII was an independent protective factor for SSI after ELAPE. Conclusion CNPDCII can effectively reduce the incidence of SSI following laparoscopic ELAPE, which is simple, safe and effective.

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“…18,19 Most studies comparing ELAPR to conventional APR for low rectal cancer demonstrate significant reductions in CRM positivity and perforation with ELAPR. [19][20][21] In a conventional APR, the patient remains in lithotomy throughout the entire procedure; however, with increasing use of ELAPR procedures, there has been increasing consideration of prone patient positioning for the perineal dissection portion of this procedure. 18,22 Performing APR in prone positioning has several benefits, such as improved visualization during perineal dissection facilitating dissection along the extralevator plane circumferentially.…”

Section: Introductionmentioning

confidence: 99%

Prone Compared With Lithotomy for Abdominoperineal Resection: A Systematic Review and Meta-analysis

McKechnie

Lee

Springer

et al. 2019

Journal of Surgical Research

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Background: Abdominoperineal resection (APR) is the primary surgical approach to low rectal cancers. Both prone and lithotomy patient positioning during the perineal dissection are currently acceptable approaches. There is no consensus on whether patient positioning has an impact on operative and oncologic outcomes. The aim of this review was to compare the perioperative and long-term oncologic outcomes between prone and lithotomy patient positioning. Materials and methods: Search of Medline, Embase, Web of Science, CENTRAL, PubMed, and ClinicalTrials.gov databases was performed. Articles were eligible for inclusion if they compared prone and lithotomy positioning for the perineal portion of APR for rectal cancer in one of the primary outcomes. Quality of included studies was assessed using Newcastle eOttawa Scale and Cochrane Risk of Bias Tool. Results: Nine studies with 888 patients in the prone group and 897 in the lithotomy group were included. Compared with lithotomy position, prone position had a significantly lower perforation rate (risk ratio: 0.50, 95% confidence interval [CI]: 0.32 to 0.79, P ¼ 0.003) and rates of positive circumferential resection margin involvement (risk ratio: 0.66, 95% CI: 0.44 to 1.00, P ¼ 0.05). Prone position also had a significantly shorter operative time than lithotomy position (mean difference: À45.20 min, 95% CI: À63.03 to-27.36, P < 0.00001). Positioning did not affect 5-y overall survival or local and distal recurrence. Conclusions: Prone positioning may lead to lower rates of perforation and circumferential resection margin involvement in APR. In addition, it may lead to shorter operative time. Larger randomized studies are required to confirm the results of this review and examine the difference in long-term outcomes.

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A comparative study of standard versus extralevator abdominoperineal resections

Cited by 3 publications

References 9 publications

Extralevator Abdominoperineal Excision (ELAPE) is Not Superior to Abdominoperineal Excision (APE) in the Era of Neoadjuvant Treatment in Rectal Cancer

Extralevator Abdominoperineal Excision (ELAPE) is Not Superior to Abdominoperineal Excision (APE) in the Era of Neoadjuvant Treatment in Rectal Cancer

Continuous Negative Pressure Drainage with Intermittent Irrigation Leaded to a Risk Reduction of Perineal Surgical Site Infection Following Laparoscopic Extralevator Abdominoperineal Excision for Low Rectal Cancer

Prone Compared With Lithotomy for Abdominoperineal Resection: A Systematic Review and Meta-analysis

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