The current abdominoperineal resection: Oncological problems and surgical modifications for low rectal cancer

Mauvais, F.; Sabbagh, Charles; Bréhant, Olivier; Viart, L.; Benhaim, T.; Fuks, David; Sinna, R.; Régimbeau, Jean‐Marc

doi:10.1016/j.jviscsurg.2011.03.001

Cited by 38 publications

(33 citation statements)

References 49 publications

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“…1 For low rectal cancers involving the sphincters, abdominoperineal resection (APR) remains a viable option. 2 The standard abdominoperineal resection an operation described by Miles was for many years the gold standard for distal rectal cancers in whom an anterior resection cannot be performed. 3 With the introduction of total mesorectal excision (TME) as the optimal technique for rectal cancer resection, oncological outcomes have generally improved.…”

Section: Introductionmentioning

confidence: 99%

A comparative study of standard versus extralevator abdominoperineal resections

Nyandowe

Egedovo

2017

Int Surg J

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Background: The aim was to compare short term outcomes between patients undergoing standard abdominoperineal resection (APR) with those that had an extralevator abdominoperineal excision (ELAPE).Methods: A retrospective study was done on 123 consecutive patients who underwent an abdominoperineal resection for low rectal cancer at the Townsville hospital between August 2003 and January 2015. Data was collected from medical records. Short term oncological outcomes were compared between the APR and ELAPE group.Results: The circumferential resection margin (CRM) involvement rate was significantly lower in the ELAPE group 13.2% versus 19.3% in the APR group. The local recurrence rates in the two groups were not significantly different: 16.8% in the ELAPE versus 17.4% in the APR group. Intraoperative perforations were lower in the ELAPE group 15.3% versus 23.2 % in the APR group. The post-operative wound infection rate was however higher in the ELAPE group 20.3% versus 12.4 % in the APR group.Conclusions: ELAPE was shown to be superior in the CRM and intraoperative perforation rate but the local recurrence rates were similar. ELAPE had a higher wound complication rate than APR.

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Section: Introductionmentioning

confidence: 99%

A comparative study of standard versus extralevator abdominoperineal resections

Nyandowe

Egedovo

2017

Int Surg J

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“…Radical resection of the rectum in the form of anterior resection and abdominoperineal resection has been advocated for many decades to achieve highest level of oncological clearance and overall survival [3][4][5][6][7][8] . The introduction of total mesorectal excision in the management of rectal cancer has also enhanced survival and reduced the risk of local recurrence [9][10][11][12][13][14] because it achieves complete excision of the rectum together with its lymphatics and lymph nodes.…”

Section: Introductionmentioning

confidence: 99%

Systematic review of oncological outcomes following laparoscopicvsopen total mesorectal excision

Sajid

Ahamd

Miles

et al. 2014

WJGE

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AIM:To systematically analyze the randomized trials comparing the oncological and clinical effectiveness of laparoscopic total mesorectal excision (LTME) vs open total mesorectal excision (OTME) in the management of rectal cancer. METHODS:Published randomized, controlled trials comparing the oncological and clinical effectiveness of LTME vs OTME in the management of rectal cancer were retrieved from the standard electronic medical databases. The data of included randomized, controlled trials was extracted and then analyzed according to the principles of meta-analysis using RevMan ® statistical software. The combined outcome of the binary variables was expressed as odds ratio (OR) and the combined outcome of the continuous variables was presented in the form of standardized mean difference (SMD). RESULTS:Data from eleven randomized, controlled trials on 2143 patients were retrieved from the electronic databases. There was a trend towards the higher risk of surgical site infection (OR = 0.66; 95%CI: 0.44-1.00; z = 1.94; P < 0.05), higher risk of incomplete total mesorectal resection (OR = 0.62; 95%CI: 0.43-0.91; z = 2.49; P < 0.01) and prolonged length of hospital stay (SMD, -1.59; 95%CI: -0.86--0.25; z = 4.22; P < 0.00001) following OTME. However, the oncological outcomes like number of harvested lymph nodes, tumour recurrence and risk of positive resection margins were statistically similar in both groups. In addition, the clinical outcomes such as operative complications, anastomotic leak and all-cause mortality were comparable between both approaches of mesorectal excision.CONCLUSION: LTME appears to have clinically and oncologically measurable advantages over OTME in patients with primary rectal cancer in both short term and long term follow ups.

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“…Оперативному лечению в объеме брюшно-промежностной экстирпации (БПЭ) подлежат 10-37 % больных РПК прямой кишки. Традиционная БПЭ характеризуется большой, до 9,5 %,частотой местных рецидивов за счет непред-намеренной перфорации стенки кишки (14-15 %) и «положительной» циркулярной границей резекции (30-40 %) [1][2][3][4][5]. Внедрение тотальной мезоректу-мэктомии в качестве стандарта хирургического лечения РПК позволило увеличить выполнение сфинктерсохраняющих операций, улучшить по-казатели общей выживаемости [6], уменьшить, но не исключить количество местных рецидивов.…”

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