Oncological Outcomes After Total Mesorectal Excision for Cure for Cancer of the Lower Rectum: Anterior vs. Abdominoperineal Resection

Wibe, Arne; Syse, Astri; Andersen, Elisabeth Anne Wreford; Tretli, Steinar; Myrvold, H. E.; Søreide, Odd

doi:10.1007/s10350-003-0012-y

Cited by 401 publications

(269 citation statements)

References 33 publications

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“…The rise in the number of ELAPE procedures performed reflects surgeons' preferences for the procedure, supported by the lower rates of local recurrence and improved survival reported by previous studies. 3,6,8 Our study did not demonstrate any oncological superiority for either of the two procedures in terms of disease free survival or long-term survival. Furthermore, there was no significant difference in overall long-term QoL between patients who had ELAPE and those who had SAPE, which is consistent with previous findings on short-term outcomes.…”

Section: Discussioncontrasting

confidence: 53%

“…2 Abdominoperineal excisions are performed for cancers within 6cm of the anal verge. 2,3 Compared with anterior resection, standard abdominoperineal excision (SAPE) is more invasive, and has higher rates of local recurrence, morbidity and mortality. 2,4,5 Over the last decade, attempts have been made to modify SAPE to reduce the rate of local recurrence and improve survival.…”

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confidence: 99%

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Oncological and quality of life outcomes following extralevator versus standard abdominoperineal excision for rectal cancer

Kamali

Sharpe

Musbahi

et al. 2017

annals

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INTRODUCTION There is increasing and conflicting research debating the oncological benefits of extralevator abdominoperineal excision (ELAPE) compared with standard abdominoperineal excision (SAPE). However, there is very little in the literature on the long-term effects on patients' wellbeing following the two procedures. The aim of this study was to determine the oncological outcomes and long-term quality of life (QoL) of patients at two hospitals having undergone ELAPE or SAPE. METHODS Consecutive patients with rectal cancer who underwent either ELAPE or SAPE between January 2009 and June 2015 at a single centre were analysed. Oncological outcomes were determined by histology and follow-up imaging. QoL data were obtained prospectively using the QLQ-C30 and QLQ-CR29 questionnaires. RESULTS A total of 48 patients (36 male, 12 female; 27 ELAPE, 21 SAPE) were reviewed. The mean age was 67.4 years and the median follow-up duration was 44 months (range: 6-79 months). Four patients (2 ELAPE, 2 SAPE) developed local recurrence. Rates of distant metastasis were similar (ELAPE: 11%, SAPE: 14%). There was no significant difference in mean global health status score (ELAPE: 77.3, SAPE: 65.3). Impotence was the most frequently reported problem (mean symptom scores of 89.7 and 78.8 for ELAPE and SAPE respectively). CONCLUSIONS This is the largest study with the longest follow-up period that compares QoL after ELAPE with that after SAPE. Although more radical in nature, ELAPE did not demonstrate any significant impact on QoL compared with SAPE. There was no significant difference in long-term oncological outcome between the groups. Impotence remains a significant problem for all patients and they should be well informed of this risk prior to surgery.

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Section: Discussioncontrasting

confidence: 53%

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confidence: 99%

Oncological and quality of life outcomes following extralevator versus standard abdominoperineal excision for rectal cancer

Kamali

Sharpe

Musbahi

et al. 2017

annals

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“…Lymph node metastases (LNM) of adenocarcinoma of the colon and rectum have been established as an independent prognostic factor [2]. Therefore, the radical resection of the local lymphdraining tissue led to a significant improvement of oncological results by lowering the local recurrence rate [3,4].…”

Section: Introductionmentioning

confidence: 99%

The Factors Effecting Lymphovascular Invasion in Adenocarcinoma of the Colon and Rectum

et al. 2013

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Adenocarcinomas of the colon and rectum are the most common gastrointestinal malignancy, and lymph node metastases are established as a prognostic factor. Lymphovascular invasion has been recognized as an indication of lymph node metastases. This prompted us to investigate the features of primary tumor that may serve as a risk factor for lymphovascular invasion in colorectal carcinoma. Clinical and pathologic tissue data of colorectal carcinoma treated in our hospital were retrieved from the computer files at Haydarpasa Numune Education and Research Hospital, from June 1998 to December 2010, retrospectively. We excluded all patients who have two-thirds distal rectal carcinoma to rule out neoadjuvant treatment bias. Tissues from the specimens were stained with standard hematoxylin and eosin. Clinical data including age and sex of patient, location and diameter of tumor, perineural invasion, peritumoral lymphocytic infiltration, tumor grade, lymphovascular invasion, Pathologic T level (pT), and lymph node metastasis were recorded. Lymphovascular invasion was present only in 43 patients out of 108. Only pT and lymph node metastases were found to be statistically significant related to lymphovascular invasion (p=0.04 and p<0.001). Perineural invasion, pT, and peritumoral lymphocytic infiltration are the factors with p<0.2 in the univariate analysis that were investigated with multivariate analysis, but no factor was found as an independent prognostic factor for lymphovascular invasion. Lymphovascular invasion is significantly related to lymph node metastases. Only pT is found as a factor that increases the lymphovascular invasion.

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“…Although neoadjuvant treatment significantly down staged tumors on final histopathology, significant portion of our patients had pT3/T4 tumors and pN2 nodal disease. It has been shown before that locally advanced pT4 tumors and pathological nodal positivity adversely impact CRM status (Wibe et al, 2004;Kenelly et al, 2013). We generally operate patients within 6-8 weeks of chemoradiation but due to tremendous workload, this was not always possible.…”

Section: Discussionmentioning

confidence: 97%

“…CRM positivity as high as 26% has been reported in patients with low rectal cancers who undergo APR (Nagtegaal et al, 2002;Bernstein et al, 2009). In modern practice, suggested target value of a positive CRM is close to 10% (Nagtegaal et al, 2002;Wibe et al, 2004). A recent study from Malaysia reported a CRM positive rate of 18.4% after long course chemoradiation and surgery (Lee et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Can Induction Chemotherapy before Concurrent Chemoradiation Impact Circumferential Resection Margin Positivity and Survival in Low Rectal Cancers?

Bhatti¹,

Waheed²,

Hafeez³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Oncological Outcomes After Total Mesorectal Excision for Cure for Cancer of the Lower Rectum: Anterior vs. Abdominoperineal Resection

Cited by 401 publications

References 33 publications

Oncological and quality of life outcomes following extralevator versus standard abdominoperineal excision for rectal cancer

Oncological and quality of life outcomes following extralevator versus standard abdominoperineal excision for rectal cancer

The Factors Effecting Lymphovascular Invasion in Adenocarcinoma of the Colon and Rectum

Can Induction Chemotherapy before Concurrent Chemoradiation Impact Circumferential Resection Margin Positivity and Survival in Low Rectal Cancers?

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