Extralevator abdominoperineal excision versus abdominoperineal excision for low rectal cancer

Abstract

Background:Extralevator abdominoperineal excision (ELAPE) has become a popular procedure for low rectal cancer as compared with abdominoperineal excision (APE). No definitive answer has been achieved whether one is superior to the other. This study aimed to evaluate the safety and efficacy of ELAPE for low rectal cancer with meta-analysis.Methods:The Web of Science, Cochrane Library, Embase, and PubMed databases before September 2019 were comprehensively searched to retrieve comparative trials of ELAPE and APE for low rectal cancer. Pooled analyses of the perioperative variables, surgical complications, and oncological variables were performed. Odds ratio (OR) and mean differences (MD) from each trial were pooled using random or fixed effects model depending on the heterogeneity of the included studies. A subgroup analysis or a sensitivity analysis was conducted to explore the potential source of heterogeneity when necessary.Results:This meta-analysis included 17 studies with 4049 patients, of whom 2248 (55.5%) underwent ELAPE and 1801 (44.5%) underwent APE. There were no statistical differences regarding the circumferential resection margin positivity (13.0% vs. 16.2%, OR = 0.69, 95% CI = 0.42–1.14, P = 0.15) and post-operative perineal wound complication rate (28.9% vs. 24.1%, OR = 1.21, 95% CI = 0.75–1.94, P = 0.43). The ELAPE was associated with lower rate of intraoperative perforation (6.6% vs. 11.3%, OR = 0.50, 95% CI = 0.39–0.64, P < 0.001) and local recurrence (8.8% vs. 20.5%, OR = 0.29, 95% CI = 0.21–0.41, P < 0.001) when compared with APE.Conclusions:The ELAPE was associated with a reduction in the rate of intra-operative perforation and local recurrence, without any increase in the circumferential resection margin positivity and post-operative perineal wound complication rate when compared with APE in the surgical treatment of low rectal cancer.

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

“…The mean of operative time in our study is 182.75 (range 120-300; SD = 39.157). 21 Similar results were found by the multicentre analysis of West et al which compared 176 ELAPE European colorectal surgical procedures with 124 standard APE performed at UK centres. 22 A retrospective cohort study by Carpelan et al found an insignificant difference in the rates of IOP and CRM involvement between the two groups.…”

Extralevator Abdominoperineal Excision (ELAPE) is Not Superior to Abdominoperineal Excision (APE) in the Era of Neoadjuvant Treatment in Rectal Cancer

“…Contradictions exist on the complication rates, CRM negativity achievement and the overall survival. Recent meta-analysis evaluates these aspects [15].…”

Laparoscopic Abdominoperineal Resection

“…The extralevator abdominoperineal excision (ELAPE) approach, described by Holm et al in 2007 [29], produces a more "cylindrical" specimen by avoidance of dissection of the mesorectum off the levators during the abdominal phase and complete (wide) excision of the levators during a prone perineal phase. A recent meta-analysis shows that ELAPE reduces IOP and local recurrence rates, without increasing perineal wound complication rates, when compared with CAPR [30]. The RELAPe randomized trial also showed no difference in complications with ELAPE, and in addition found a statistically significant reduction in CRM positivity rates, compared to non-ELAPE [31].…”