Local recurrence after abdomino‐perineal resection

Davies, M; Harries, D. J.; Hirst, G. R.; Beynon, Rebecca; Morgan, A. R.; Carr, N. D.; Beynon, J.

doi:10.1111/j.1463-1318.2008.01520.x

Cited by 35 publications

(19 citation statements)

References 16 publications

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“…CRM positivity following APER as described in different studies varies between 15% and 30%. 12,13 Our CRM positivity rate was 27%, which is comparable to previous literature. Heald and colleagues 14 presented the concept that the recurrences after rectal cancer surgery could be secondary to inadequate excision of the mesorectum.…”

Section: Discussionsupporting

confidence: 91%

Evaluation of the Impact of Implementing the Prone Jackknife Position for the Perineal Phase of Abdominoperineal Excision of the Rectum

Tayyab¹,

Sharma²,

Ragg³

et al. 2012

Diseases of the Colon &Amp; Rectum

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Section: Discussionsupporting

confidence: 91%

Evaluation of the Impact of Implementing the Prone Jackknife Position for the Perineal Phase of Abdominoperineal Excision of the Rectum

Tayyab¹,

Sharma²,

Ragg³

et al. 2012

Diseases of the Colon &Amp; Rectum

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“…The Mayo Clinic group reported just 5.5% local recurrence rate in which APER comprised 38% of the series in a cohort of 655 patients treated without RT, in which over 20% had stage III rectal tumours 28. Data from Swansea reports equivalent rates of margin involvement, local recurrence and survival in T3/T4 node positive rectal cancers in which neoadjuvant treatment was reserved for predicted margin involvement and significant nodal disease,29 which is confirmed by longitudinal analysis of this selective approach to RT 30. Given the improvements in CRM rates and local recurrence with the modern APE, it is timely to scrutinise the role of neoadjuvant RT in this setting.…”

Section: Discussionmentioning

confidence: 85%

Protocol for a multicentre randomised feasibility trial evaluating early Surgery Alone In LOw Rectal cancer (SAILOR)

et al. 2016

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IntroductionThere are 11 500 rectal cancers diagnosed annually in the UK. Although surgery remains the primary treatment, there is evidence that preoperative radiotherapy (RT) improves local recurrence rates. High-quality surgery in rectal cancer is equally important in minimising local recurrence. Advances in MRI-guided prediction of resection margin status and improvements in abdominoperineal excision of the rectum (APER) technique supports a reassessment of the contribution of preoperative RT. A more selective approach to RT may be appropriate given the associated toxicity.Methods and analysisThis trial will explore the feasibility of a definitive trial evaluating the omission of RT in resectable low rectal cancer requiring APER. It will test the feasibility of randomising patients to (1) standard care (neoadjuvant long course RT±chemotherapy and APER, or (2) APER surgery alone for cT2/T3ab N0/1 low rectal cancer with clear predicted resection margins on MRI. RT schedule will be 45 Gy over 5 weeks as current standard, with restaging and surgery after 8–12 weeks. Recruitment will be for 24 months with a minimum 12-month follow-up.ObjectivesObjectives include testing the ability to recruit, consent and retain patients, to quantify the number of patients eligible for a definitive trial and to test feasibility of outcomes measures. These include locoregional recurrence rates, distance to circumferential resection margin, toxicity and surgical complications including perineal wound healing, quality of life and economic analysis. The quality of MRI staging, RT delivery and surgical specimen quality will be closely monitored.Ethics and disseminationThe trial is approved by the Regional Ethics Committee and Health Research Authority (HRA) or equivalent. Written informed consent will be obtained. Serious adverse events will be reported to Swansea Trials Unit (STU), the ethics committee and trial sites. Trial results will be submitted for peer review publication and to trial participants.Trial registration numberISRCTN02406823.

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“…As a result, improved outcomes might have been accounted for by changes in staging and treatment strategies rather than the surgery itself. This theory is further strengthened by the fact that many of the wellknown centers across the world have shown quite good results with conventional APER (19).…”

Section: Technique Of Elapermentioning

confidence: 95%

Selective extra levator versus conventional abdomino perineal resection: experience from a tertiary-care center

Pai

Patil

Arya

et al. 2016

J. Gastrointest. Oncol.

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Background: To compare extra levator abdomino perineal resection (ELAPER) with conventional abdominoperineal resection (APER) in terms of short-term oncological and clinical outcomes.Methods: This is a retrospective review of a prospectively maintained database including all the patients of rectal cancer who underwent APER at Tata Memorial Center between July 1, 2013, and January 31, 2015.Short-term oncological parameters evaluated included circumferential resection margin involvement (CRM), tumor site perforation, and number of nodes harvested. Peri operative outcomes included blood loss, length of hospital stay, postoperative perineal wound complications, and 30-day mortality. The χ 2 -test was used to compare the results between the two groups.Results: Forty-two cases of ELAPER and 78 cases of conventional APER were included in the study.Levator involvement was significantly higher in the ELAPER compared with the conventional group; otherwise, the two groups were comparable in all the aspects. CRM involvement was seen in seven patients (8.9%) in the conventional group compared with three patients (7.14%) in the ELAPER group. Median hospital stay was significantly longer with ELAPER. The univariate analysis of the factors influencing CRM positivity did not show any significance.Conclusions: ELAPER should be the preferred approach for low rectal tumors with involvement of levators. For those cases in which levators are not involved, as shown in preoperative magnetic resonance imaging (MRI), the current evidence is insufficient to recommend ELAPER over conventional APER. This stresses the importance of preoperative MRI in determining the best approach for an individual patient.

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Local recurrence after abdomino‐perineal resection

Cited by 35 publications

References 16 publications

Evaluation of the Impact of Implementing the Prone Jackknife Position for the Perineal Phase of Abdominoperineal Excision of the Rectum

Evaluation of the Impact of Implementing the Prone Jackknife Position for the Perineal Phase of Abdominoperineal Excision of the Rectum

Protocol for a multicentre randomised feasibility trial evaluating early Surgery Alone In LOw Rectal cancer (SAILOR)

Selective extra levator versus conventional abdomino perineal resection: experience from a tertiary-care center

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