Extralevator versus standard abdominoperineal excision for rectal cancer

Perdawood, Sharaf Karim; Lund, Teija

doi:10.1007/s10151-014-1243-8

Cited by 28 publications

(25 citation statements)

References 39 publications

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“…To resolve these problems and improve patient survival, ELAPE emerged and proven to effectively reduce CRM involvement and bowel performation[15, 16]. However, there were also researches showed that ELAPE not always reduces CRM positivity [17]. In our study, we found that there was no positive CRM or intraoperative perforation in all patients.…”

Section: Discussionmentioning

confidence: 51%

Extralevator abdominoperineal excision for rectal cancer with biological mesh for pelvic floor reconstruction

Jiang

Wang

et al. 2016

Oncotarget

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GoalTo share our experience of extra-levator abdominoperineal excision (ELAPE) for low rectal cancer, focusing on perineal repair with biological mesh.MethodsWe retrospectively analyzed medical records of all patients with low rectal cancer who underwent the ELAPE procedure using biological mesh for perineal repair at the Gastrointestinal Surgery of Nanjing Drum Power Hospital between January 2013 and September 2015. All patients were closely followed up to now.ResultsA total of 17 patients underwent ELAPE for low rectal cancer was screened. Of these, 15 patients had primary rectal cancer, 1 had local recurrent rectal cancer, and 1 had malignant melanoma. All patients underwent ELAPE successfully without intestinal perforation and got stage I healing in perineum wound without incision infection, dehiscence, cystocele perinealis, urethral dysfunction or intestinal obstruction. Perineum wound hematoma developed in just one patient and had successful percutaneous drainage in one week. During the follow-up, there was no recurrence, perineal hernia, sexual dysfunction, urinary retention, or bowel obstruction. Two patients described slight pain in the sacrococcygeal region without special handling.ConclusionELAPE is applicable to low rectal cancer. Biological mesh reconstruction of perineal defect seems to be safe and effective, with high patient compliance.

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Section: Discussionmentioning

confidence: 51%

Extralevator abdominoperineal excision for rectal cancer with biological mesh for pelvic floor reconstruction

Jiang

Wang

et al. 2016

Oncotarget

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“…Obviously the length operative time and of hospital stay and perineal wound-related complications are high. 18 West NP et al, form European Extralevator Abdominoperineal Excision Study group described the wider extra levator resection of the rectal stump and showed the CRM is less involved but the perineal wound complication rate is high. 13 The same group in Journal of Clinical Oncology reported the cylindrical technique removed more tissue in the distal rectum and in all slices that contained tumour compared with the standard operation (both p<0.0001).…”

Section: Discussionmentioning

confidence: 99%

Treatment of advanced rectal cancers: Cylindrical abdominoperineal excision of rectum

Lamichhane

Walker

2018

J. Soc. Surg. Nepal

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Introduction: Treatment for patients with locally advanced low lying rectal cancer differs significantly from patients with rectal cancer restricted to the mesorectum. They require multimodality treatment, including preoperative chemo-radiation and extended surgical resection. Cylindrical abdominoperineal excision of rectum (C-APER) along with possible composite pelvic organ resection is a surgical method to remove an adequate circumferential margin. Method: Patients with the diagnosis of advanced rectal cancers over a period of 9 months are included in this study. Therapeutic approach of C-APER is taken for these patients with focus on multimodality treatment protocols to downstage the tumours and extended resections to enable complete removal of all tumour tissue with clear surgical margins. Consecutive review of cases of advanced rectal cancer to their immediate surgical outcome were done. Results: Five patients with compromised CRM in MRI of rectum, 4 were treated with Neoadjuvant FOLFOX 6 regimen chemotherapy 3 cycles and Short course Radiotherapy. All underwent surgery 6-8 weeks after treatment. The pelvic floor was repaired with biological mesh in 1 and synthetic mesh in 4. The pathological stage of disease remained T3 and above despite neoadjuvant treatment in majority of patients but none of them had positive CRM. The wound complication rates were high in the perineum with serous discharge in almost every patient and one patient needing long term vacuum assisted dressing in the community. Conclusion: The surgery is technically feasible with acceptable morbidity in short term with possible long term outcome of reduced loco-regional failure.

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“…In this study, we observed that PPR following LAPR technique is safe and effective procedure for patients with low rectal cancer. As LAPR is associated with worse outcomes compared with anterior resection in terms of local recurrence and overall prognosis it requires improved surgical technique [5]. In LAPR, inadequate resection leads to increased risk of positive CRM and perforation.…”

Section: Discussionmentioning

confidence: 99%

“…Laparoscopic abdominoperineal resection (LAPR) for rectal cancer has been widely used in clinical practice [1][2][3][4]. This technique requires narrow excision of the entire pelvic floor and the anorectum but uses more radical dissection of the perianal skin or ischioanal fat compared with extralavator abdominoperineal excision (ELAPE) [5]. Numerous prospective randomized control trials have confirmed its safety and feasibility [6,7].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Pelvic Peritoneal Reconstruction following Laparoscopic Abdomino-Perineal Resection of the Rectum in the treatment of Lower Rectal Cancer: A comparative Study and review

Iqbal¹,

Ullah²,

Uddin³

et al. 2017

IOSR JDMS

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Background: Laparoscopic abdominoperineal resection (LAPR) for rectal cancer poses a difficult challenge for surgeons regarding pelvic peritoneal reconstruction. Therefore, in this study, we investigate the effectiveness of pelvic peritoneal reconstruction following LAPR in the treatment of rectal cancer. Methods: We retrospectively reviewed clinical data records of patients who were treated with LAPR for rectal cancer in our hospital. Patients were included if they met predetermined inclusion criteria. All included patients were divided into two groups: group A (LAPR with pelvic peritoneum reconstruction (PPR) and group B (LAPR without PPR). For each included patients, following data were record: age, sex, body mass index (BMI), ASA score (American society of anesthesiologists), cancer staging, duration of operation, amount of blood loss, hospital stay, retrieved lymph nodes, time until start of flatus and oral intake and complications (early or late). Following endpoints were analyzed: operation time, intra-operative blood loss, and post-operative complication rate. Results: A total of 146 patients underwent LAPR including 48 patients with PPR (group A) and 98 patients without PPR (group B). LAPR procedures were successful in all included patients, with no patient requiring conversion to an open approach. The mean duration of follow-up was 12 months (range, 9 to 15 months) in both groups. There was significant difference in both groups regarding operation time, duration of hospital stay and follow up, and prevalence of late complications such as intestinal obstruction and tumour recurrence (p<0.05). No statistical difference was observed regarding demographic data, intra-operative blood loss and prevalence of early complications (p>0.05). Conclusion: LAPR technique is safe and effective procedure for patients with lower rectal cancer. Authors strongly recommend PPR following LAPR.

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Extralevator versus standard abdominoperineal excision for rectal cancer

Cited by 28 publications

References 39 publications

Extralevator abdominoperineal excision for rectal cancer with biological mesh for pelvic floor reconstruction

Extralevator abdominoperineal excision for rectal cancer with biological mesh for pelvic floor reconstruction

Treatment of advanced rectal cancers: Cylindrical abdominoperineal excision of rectum

Efficacy of Pelvic Peritoneal Reconstruction following Laparoscopic Abdomino-Perineal Resection of the Rectum in the treatment of Lower Rectal Cancer: A comparative Study and review

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