A prospective case–control study of extralevator abdominoperineal excision (ELAPE) of the rectum versus conventional laparoscopic and open abdominoperineal excision: comparative analysis of short-term outcomes and quality of life

Vaughan-Shaw, Peter G; Cheung, Tik Shing; Knight, J. S.; Nichols, P. H.; Pilkington, Sophie; Mirnezami, Alex H.

doi:10.1007/s10151-012-0851-4

Cited by 37 publications

(29 citation statements)

References 29 publications

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“…19 While no significant differences were observed between the two patient groups in our study, our findings are generally similar to previous results. 15 With regard to QoL, the mean global health status score for the ELAPE cohort of 79.2 is lower than reported previously. 15 This could be explained by the longer follow-up period in our study.…”

Section: Kamali Sharpe Musbahi Reddy Oncological and Quality Of Life contrasting

confidence: 61%

“…15 With regard to QoL, the mean global health status score for the ELAPE cohort of 79.2 is lower than reported previously. 15 This could be explained by the longer follow-up period in our study. Other factors such as initial health status prior to surgery and postoperative aftercare could also help to explain this difference.…”

Section: Kamali Sharpe Musbahi Reddy Oncological and Quality Of Life contrasting

confidence: 61%

“…This may reassure surgeons who choose not to perform ELAPE owing to reservations about the operation being too radical for patients who are frail or who have multiple co-morbidities. 15 In addition, there was no significant difference between the oncological outcomes or longer-term QoL after laparoscopic and open ELAPE. Although not statistically significant, a greater total number of laparoscopic resections were followed by recurrent disease.…”

Section: Kamali Sharpe Musbahi Reddy Oncological and Quality Of Life mentioning

confidence: 86%

“…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. 9,15 Standardised pathological grading of resected specimens is now recognised as essential for patient care and as a marker of surgical technique. An additional three-stage classification system was proposed by Nagtegaal et al in 2002 to grade specimens at the level of the levators.…”

Section: Discussionmentioning

confidence: 99%

“…These findings are similar to another study, reporting scores of 75 and 100 respectively. 15 Impotence is a significant adverse side effect; it can be secondary to direct trauma to the nerves and vessels in the pelvic cavity during the resection. The surgeons at our trust perform the perineal component of ELAPE via an extended prone perineal approach with removal of the coccyx, as described by Holm et al 2 We believe this provides better visualisation of the operative field.…”

Section: Kamali Sharpe Musbahi Reddy Oncological and Quality Of Life mentioning

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: Kamali Sharpe Musbahi Reddy Oncological and Quality Of Life contrasting

confidence: 61%

Section: Kamali Sharpe Musbahi Reddy Oncological and Quality Of Life contrasting

confidence: 61%

Section: Kamali Sharpe Musbahi Reddy Oncological and Quality Of Life mentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Kamali Sharpe Musbahi Reddy Oncological and Quality Of Life mentioning

confidence: 99%

See 3 more Smart Citations

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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Quality of Life After Surgery for Rectal Cancer

Gavaruzzi

Giandomenico

Bianco

et al. 2014

Early Gastrointestinal Cancers II: Rectal Cancer

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Patients' health-related quality of life (HRQoL) is now considered a relevant clinical outcome. This study systematically reviewed articles published in the last 5 years, focusing on the impact of rectal cancer treatment on patients' HRQoL. Of the 477 articles retrieved, 56 met the inclusion criteria. The most frequently reported comparisons were between surgical procedures (21 articles), especially between sphincter-preserving and non-sphincter preserving surgery or between stoma and stoma-free patients (13 articles), and between multimodality therapies (11 articles). Additionally, twelve articles compared patients' and healthy controls' HRQoL as primary or secondary aim. The majority of the studies were observational (84 %), controlled (66 %), cross-sectional (54 %), prospective (100 %), with a sample of more than 100 patients (59 %), and with more than 60 % of patients treated with neoadjuvant therapy (50 %). The most frequently used instruments were the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQ-C30), its colorectal cancer specific module QLQ-CR38, and the Medical Outcomes Study Short-Form 36 items questionnaire. Findings from the included articles are summarised and commented, with a special focus on the comparison between surgical treatments, between irradiated and not-irradiated patients, and between patients and the general population.

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Laparoscopic Procedures: Laparoscopic Abdominoperineal Resection

Foster

Francis

2017

Techniques in Minimally Invasive Rectal Surgery

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A prospective case–control study of extralevator abdominoperineal excision (ELAPE) of the rectum versus conventional laparoscopic and open abdominoperineal excision: comparative analysis of short-term outcomes and quality of life

Abstract: The results of this study suggest that ELAPE is not associated with deterioration in short-term outcomes or QOL when compared with LAPE or OAPE.

Cited by 37 publications

References 29 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

Quality of Life After Surgery for Rectal Cancer

Laparoscopic Procedures: Laparoscopic Abdominoperineal Resection

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