Short-term outcomes of the modified extralevator abdominoperineal resection for low rectal cancer (with videos)

Abstract

The modified extralevator abdominoperineal resection was feasible and safe for patients with low rectal cancer with extended perineal dissection and convenient direct wound closure.

Perineal hernia repair after abdominoperineal rectal excision with prosthetic mesh—a single surgeon experience

“…Most of the time, only the ischiorectal fat and the skin are left for closure of the perineal defect after ELAPE making perineal herniation possible [8]. The time between surgery and hernia formation is from 6 months to 5 years [9].…”

Perineal closure following extralevator abdominoperineal excision for cancer of the rectum

“…These include omentoplasty , myocutaneous gracilis flaps , gluteal flaps , rectus abdominis myocutaneous flaps and the insertion of prosthetic materials such as Permacol™ (Covidien, Dublin, Ireland) [,]. Modified techniques to improve perineal healing have also been proposed , including the use of negative‐pressure wound therapy .…”

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“…3 Not less important, distinction of three or two 4 forms of ELAPE in relation to the perineal dissection has also been a matter of debate, despite the general recognition that ELAPE is frequently accompanied by increased perineal morbidity either in lithotomy or prone positions. 5 As rates of perineal wound complications are high (35-66%) and related with radiotherapy, 6 surgeons have tried to overcome this problem by using muscle graft (myocutaneous flaps), biological mesh fixation or even closure to prevent local hernias.…”

“…It has been proposed that RNM information is essential when considering alternative approaches. 8,9 Although ELAPE is considered effective in reducing local recurrence, intraoperative tumour perforations and CRM positivity, 10 the reported oncological 6,11,12 and morbidity outcomes 13,14 compared to conventional APR are not uniform. This absence of difference might be due to a more radical performance of the so-called conventional APR or to pathological features of treated cases.…”

“…This choice is also associated with shorter operative times and less blood loss. 6 Outcomes must be addressed in terms of oncological results and postoperative complications. In this manuscript, results were compared with an historical cohort of patients.…”