Extralevator Abdominal Perineal Excision Versus Standard Abdominal Perineal Excision: Impact on Quality of the Resected Specimen and Postoperative Morbidity

Habr‐Gama, Angelita; Julião, Guilherme P. São; Mattacheo, Adrian; Campos-Lobato, Luiz Felipe de; Alemán, E.; Vailati, Bruna Borba; Gama-Rodrigues, Joaquim; Perez, Rodrigo Oliva

doi:10.1007/s00268-017-3963-1

Cited by 29 publications

(36 citation statements)

References 37 publications

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“…In addition, our results showed that 5-year OS and DFS rates were poorer for LRC patients compared with M/HRC patients after laparoscopic surgery, which is consistent with previous literatures [10,14], although these studies were not focused exclusively on laparoscopic surgery. Chiang et al [10] noted that the rectal cancer level signi cantly affected the long-term survival and patterns of distant metastases for patients who underwent surgical resection.…”

Section: Discussionsupporting

confidence: 92%

“…Compared with mid-rectal and upper-rectal cancers, LRC had the worst prognosis. Cheng et al [14] divided T3/T4 rectal cancer patients who underwent surgery into high and mid/low rectal cancer, they found that patients with stage III high rectal cancer demonstrated better prognosis than those with mid/low rectal cancer, and tumor location was an independent prognostic factor for long-term survival. However, other studies have come to different conclusions, meaning that tumor location has no in uence on long-term outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Considering the small number of patients with recurrence in the series, this nding should be regarded with caution. Cheng et al [14] found that the location of rectal cancer was a signi cant risk factor for local recurrence, lung metastasis, bone metastasis and systemic lymph node metastasis, as the tumor distance from the anal verge decreased, the risk for recurrence signi cantly increased. Frambach et al [16] retrospectively analyzed 378 patients with locally advanced rectal cancer treated with NAT and curative surgery.…”

Section: Discussionmentioning

confidence: 99%

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Influence of Tumor Location on Short- and Long-Term Outcomes After Laparoscopic Surgery for Rectal Cancer: A Propensity Score Matched Cohort Study

Yang

Yao

Cui

et al. 2020

Preprint

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Background: This study aimed to evaluate the short- and long-term outcomes after laparoscopic resection for low rectal cancer (LRC) compared with mid/high rectal cancer (M/HRC). Methods: Patients with rectal cancer undergoing laparoscopic resection with curative intent were retrospectively reviewed between 2009 and 2015. After matched 1:1 by using propensity score analysis, perioperative and oncological outcomes were compared between LRC and M/HRC groups. Multivariate analysis was performed to identify independent factors of overall survival (OS) and disease-free survival (DFS). Results: Of 373 patients who met the criteria for inclusion, 198 patients were matched for the analysis. Laparoscopic surgery for LRC required longer operative time (P＜0.001) and more blood loss volume (P=0.015) compared with M/HRC, and the LRC group tended to have a higher incidence of postoperative complications (16.2% vs. 8.1%, P=0.082). There was no significant difference in local recurrence between the two groups (9.1% vs. 4.0%, P=0.251), whereas distant metastasis was inclined to be more frequent in LRC patients compared with M/HRC (21.2% vs. 12.1%, P=0.086). The LRC group showed significantly inferior 5-year OS (77.0% vs. 86.4%, P=0.033) and DFS (71.2% vs. 86.2%, P=0.017) compared with the M/HRC group. Multivariate analysis indicated that tumor location was an independent predictor of DFS (HR=2.305, 95% CI 1.203-4.417, P=0.012). Conclusion: Tumor location of the rectal cancer significantly affected the clinical and oncological outcomes after laparoscopic surgery, and it was an independent predictor of DFS.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Influence of Tumor Location on Short- and Long-Term Outcomes After Laparoscopic Surgery for Rectal Cancer: A Propensity Score Matched Cohort Study

Yang

Yao

Cui

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…[25][26][27][28] An additional of 4 studies with full text of the original paper only were included. 9,10,29,30 Eleven studies without separate data for OP, [31][32][33][34][35][36][37][38][39][40][41] and 1 study that eventually appeared to have included only 1 patient with OP 42 were excluded.…”

Section: Literature Search and Selectionmentioning

confidence: 99%

A Systematic Review and Meta-analysis on Omentoplasty for the Management of Abdominoperineal Defects in Patients Treated for Cancer

Blok

Hagemans²,

Klaver

et al. 2020

Annals of Surgery

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The objective of this systematic review and meta-analysis was to examine the effects of omentoplasty on pelviperineal morbidity following abdominoperineal resection (APR) in patients with cancer. Background: Recent studies have questioned the use of omentoplasty for the prevention of perineal wound complications. Methods: A systematic review of published literature since 2000 on the use of omentoplasty during APR for cancer was undertaken. The authors were requested to share their source patient data. Meta-analyses were conducted using a random-effects model. Results: Fourteen studies comprising 1894 patients (n ¼ 839 omentoplasty) were included. The majority had APR for rectal cancer (87%). Omentoplasty was not significantly associated with the risk of presacral abscess formation in the overall population (RR 1.11; 95% CI 0.79-1.56), nor in planned subgroup analysis (n ¼ 758) of APR with primary perineal closure for nonlocally advanced rectal cancer (RR 1.06; 95% CI 0.68-1.64). No overall differences were found for complicated perineal wound healing within 30 days (RR 1.30; 95% CI 0.92-1.82), chronic perineal sinus (RR 1.08; 95% CI 0.53-2.20), and pelviperineal complication necessitating reoperation (RR 1.06; 95% CI 0.80-1.42) as well. An increased risk of developing a perineal hernia was found for patients submitted to omentoplasty (RR 1.85; 95% CI 1.26-2.72). Complications related to the omentoplasty were reported in 4.6% (95% CI 2.5%-8.6%). Conclusions: This meta-analysis revealed no beneficial effect of omentoplasty on presacral abscess formation and perineal wound healing after APR, while it increases the likelihood of developing a perineal hernia. These findings do not support the routine use of omentoplasty in APR for cancer.

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“…APR or ELAPE was recommended when the levator muscle was invaded or preservation of the anus was impracticable. The perineal surgery and terminal colostomy were performed as described in the literature [14].…”

Section: Interventionsmentioning

confidence: 99%

Influence of tumor location on short- and long-term outcomes after laparoscopic surgery for rectal cancer: a propensity score matched cohort study

et al. 2020

View full text Add to dashboard Cite

Background: This study aimed to evaluate the short-and long-term outcomes after laparoscopic resection for low rectal cancer (LRC) compared with mid/high rectal cancer (M/HRC). Methods: Patients with rectal cancer undergoing laparoscopic resection with curative intent were retrospectively reviewed between 2009 and 2015. After matched 1:1 by using propensity score analysis, perioperative and oncological outcomes were compared between LRC and M/HRC groups. Multivariate analysis was performed to identify independent factors of overall survival (OS) and disease-free survival (DFS). Results: Of 373 patients who met the criteria for inclusion, 198 patients were matched for the analysis. Laparoscopic surgery for LRC required longer operative time (P<0.001) and more blood loss volume (P = 0.015) compared with M/HRC, and the LRC group tended to have a higher incidence of postoperative complications (16.2% vs. 8.1%, P = 0.082). There was no significant difference in local recurrence between the two groups (9.1% vs. 4.0%, P = 0.251), whereas distant metastasis was inclined to be more frequent in LRC patients compared with M/ HRC (21.2% vs. 12.1%, P = 0.086). The LRC group showed significantly inferior 5-year OS (77.0% vs. 86.4%, P = 0.033) and DFS (71.2% vs. 86.2%, P = 0.017) compared with the M/HRC group. Multivariate analysis indicated that tumor location was an independent predictor of DFS (HR = 2.305, 95% CI 1.203-4.417, P = 0.012). Conclusion: Tumor location of the rectal cancer significantly affected the clinical and oncological outcomes after laparoscopic surgery, and it was an independent predictor of DFS.

show abstract

Extralevator Abdominal Perineal Excision Versus Standard Abdominal Perineal Excision: Impact on Quality of the Resected Specimen and Postoperative Morbidity

Abstract: ELAPE may be safely implemented into routine clinical practice with no increase in postoperative morbidity and considerable improvements in the quality of the resected specimen of patients with low rectal cancers.

Cited by 29 publications

References 37 publications

Influence of Tumor Location on Short- and Long-Term Outcomes After Laparoscopic Surgery for Rectal Cancer: A Propensity Score Matched Cohort Study

Influence of Tumor Location on Short- and Long-Term Outcomes After Laparoscopic Surgery for Rectal Cancer: A Propensity Score Matched Cohort Study

A Systematic Review and Meta-analysis on Omentoplasty for the Management of Abdominoperineal Defects in Patients Treated for Cancer

Influence of tumor location on short- and long-term outcomes after laparoscopic surgery for rectal cancer: a propensity score matched cohort study

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