Current practice in abdominoperineal resection: an email survey of the membership of the Association of Coloproctology

Abstract

INTRODUCTION This study aimed to gain insight into current preferences for type of surgical approach and patient positioning in abdominoperineal excision of the rectum (APER), to identify whether these factors affect self-reported oncological outcomes and complication rates, and to assess the opinions of members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) with regards to the benefit of a national training programme for APER surgery. METHODS Members of the ACPGBI were surveyed using a questionnaire designed to examine surgeon/departmental demographics, type of APER practised, audit of results and complications, opinions regarding extralevator APER (ELAPER) and opinions regarding the potential benefit of a national training programme. RESULTS According to the survey, 62% of surgeons perform perineal dissection in the supine position and 57% perform a standard APER technique. Surgeons who only practise colorectal surgery (p=0.002) and surgeons performing prone dissection (p<0.0001) are more likely to perform ELAPER. Three-quarters (76%) audit their results for perineal wound complication rates. Over 80% audit their oncological outcomes. The vast majority (94.6%) of those who perform ELAPER believe there is a benefit to this method while 59.6% of those who do not perform ELAPER still believe there is a benefit to ELAPER. Only 50% feel that there should be a national training programme. CONCLUSIONS There is a distinct discordance with regards to the APER technique. Among UK colorectal surgeons, although a significant proportion favours ELAPER, there remains a larger proportion still performing standard APER techniques.

Circumferential resection margins and perineal complications after neoadjuvant long‐course chemoradiotherapy followed by extralevator abdominoperineal excision of the rectum: Five years of activity at a single institution

“…Similarly, the prone jack‐knife position for the perineal phase provides excellent pelvic exposure and it seems more comfortable for the operating surgeons facilitating the dissection particularly in the anterior plane. In 2012, an online survey asked members of the Association of Coloproctology of Great Britain and Ireland about their surgical management of low rectal cancers . The prone position was adopted by 38.1% of answering surgeons, the ELAPE by 44.2% of them and surgeons using the prone approach were also more likely to perform ELAPE compared to APER .…”

Oncological outcomes of abdominoperineal resection for the treatment of low rectal cancer: A retrospective review of a single UK tertiary centre experience

“…The use of ELAPE in the management of low rectal cancer is growing [21]. This increase is in response to reported poor surgical outcomes following standard APR when compared to anterior resection [1].…”

Biologic meshes in perineal reconstruction following extra‐levator abdominoperineal excision (elAPE)

“…According to a recent UK national survey data approximately 20% of elAPE cases are performed with primary closure of the perineal wound [11]. However, the size of the perineal defect necessitates tension on the sutures.…”