Multicenter study of surgical and oncologic outcomes of extra-levator versus conventional abdominoperineal excision for lower rectal cancer

Shen, Zhanlong; Bu, Zhaode; Li, Ang; Lu, Junliang; Zhu, Li-Yu; Chong, Choon Seng; Gao, Zhidong; Jiang, Kewei; Wang, Shan; Li, Fēi; Xiao, Yi; Ji, Jiafu; Ye, Yingjiang

doi:10.1016/j.ejso.2019.08.017

Cited by 12 publications

(12 citation statements)

References 28 publications

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“…ISR is an anatomically planned technique with specific well-described steps and anatomical landmarks [ 19 , 21 ]. Only recently, APR was standardized into three techniques according to well-defined anatomical structures to improve the oncological results: intersphincteric, extralevator, and ischioanal APR [ 3 , 146 , 147 ]. Therefore, when ISR is compared to APR, it should be specified which type of APR was performed.…”

Section: Isr Vs Aprmentioning

confidence: 99%

Anus-Preserving Surgery in Advanced Low-Lying Rectal Cancer: A Perspective on Oncological Safety of Intersphincteric Resection

Piozzi

Baek

Kwak

et al. 2021

Cancers

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The surgical management of low-lying rectal cancer, within 5 cm from the anal verge (AV), is challenging due to the possibility, or not, to preserve the anus with its sphincter muscles maintaining oncological safety. The standardization of total mesorectal excision, the adoption of neoadjuvant chemoradiotherapy, the implementation of rectal magnetic resonance imaging, and the evolution of mechanical staplers have increased the rate of anus-preserving surgeries. Moreover, extensive anatomy and physiology studies have increased the understanding of the complexity of the deep pelvis. Intersphincteric resection (ISR) was introduced nearly three decades ago as the ultimate anus-preserving surgery. The definition and indication of ISR have changed over time. The adoption of the robotic platform provides excellent perioperative results with no differences in oncological outcomes. Pushing the boundaries of anus-preserving surgeries has risen doubts on oncological safety in order to preserve function. This review critically discusses the oncological safety of ISR by evaluating the anatomical characteristics of the deep pelvis, the clinical indications, the role of distal and circumferential resection margins, the role of the neoadjuvant chemoradiotherapy, the outcomes between surgical approaches (open, laparoscopic, and robotic), the comparison with abdominoperineal resection, the risk factors for oncological outcomes and local recurrence, the patterns of local recurrences after ISR, considerations on functional outcomes after ISR, and learning curve and surgical education on ISR.

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Section: Isr Vs Aprmentioning

confidence: 99%

Anus-Preserving Surgery in Advanced Low-Lying Rectal Cancer: A Perspective on Oncological Safety of Intersphincteric Resection

Piozzi

Baek

Kwak

et al. 2021

Cancers

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“…Lehtonen et al [8] showed that ELAPE for T3-4 lower RC reduced local recurrence rates (6.7% vs. 15.5%, P = 0.048). Shen et al [9] reported that ELAPE improved overall survival (41.5 months vs. 29.8 months, P = 0.028) and disease-free survival (38.5 months vs. 29.3 months, P = 0.027). In contrast, Prytz et al [11] reported that ELAPE had a high 3-year risk of local recurrence (odds ratio 4.10, 95% confidence interval 1.19-14.08).…”

Section: Discussion and Con Clus Ionsmentioning

confidence: 99%

“…To improve prognosis, extralevator abdominoperineal excision (ELAPE), a more extensive procedure than standard APR, was introduced [5]. ELAPE has been reported to improve oncological outcomes [6][7][8][9] due to its enlarged resection area; however, some studies have reported that ELAPE does not improve outcomes [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Widespread anorectal lymphovascular networks and tissue drainage: analyses from submucosal India ink injection and indocyanine green fluorescence imaging

et al. 2021

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“…This surgical technique has shown better oncological outcomes than conventional APE. 16,17 The main problems cited are IOP and positive CRM, which in the case of ELAPE surgical technique are present significantly less relative to APE. 18 Furthermore, the advantage of the ELAPE procedure in a prone position also lies in better cooperation of the whole surgical team due to better visibility and comfort.…”

Section: Discussionmentioning

confidence: 99%

Extralevator abdominoperineal excision for low rectal cancer: oncological outcome after five-year follow-up

et al. 2021

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BACKGROUND: Extralevator abdominoperineal excision (ELAPE) is a surgical technique that is indicated for low rectal cancer where sphincter preservation is not possible. Compared to conventional abdominoperineal excision major advantages of ELAPE are the risk reduction of intraoperative bowel perforation and positive circumferential margin which lead to a better oncological outcome. The aim of this study was to present our results in ELAPE surgery METHODS: From February 2011 to February 2015, 40 patients underwent surgery for low rectal cancer at the Oncology Institute of Vojvodina. The collected data included sex, age, preoperative staging, neoadjuvant treatment, operative time, rate of intraoperative bowel perforation, rate of positive circumferential resection margins, histopathological analysis, postoperative mortality, tumour, node and metastasis (TNM) classification, local recurrence (LR) rate and presence of distant metastases RESULTS: Positive circumferential margin was found in three (7.5%) patients while eight (20%) patients had intraoperative bowel perforation. LR during follow-up was seen in seven (17.5%) patients, three of them had intraoperative bowel perforation and two patients had positive circumferential margin. The estimated five-year cumulative incidence of LR is 7%. Distant metastases occurred in 18 (45%) patients. The estimated five-year survival rate is 62% CONCLUSION: The study shows satisfactory five-year survival rates of 62% in a highly complex patient group treated by ELAPE procedure Keywords: rectal cancer, extralevator abdominoperineal excision, local recurrence, overall survival

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Multicenter study of surgical and oncologic outcomes of extra-levator versus conventional abdominoperineal excision for lower rectal cancer

Cited by 12 publications

References 28 publications

Anus-Preserving Surgery in Advanced Low-Lying Rectal Cancer: A Perspective on Oncological Safety of Intersphincteric Resection

Anus-Preserving Surgery in Advanced Low-Lying Rectal Cancer: A Perspective on Oncological Safety of Intersphincteric Resection

Widespread anorectal lymphovascular networks and tissue drainage: analyses from submucosal India ink injection and indocyanine green fluorescence imaging

Extralevator abdominoperineal excision for low rectal cancer: oncological outcome after five-year follow-up

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