Extralevator versus standard abdominoperineal excision in locally advanced rectal cancer: a retrospective study with long-term follow-up

Abstract

We found a non-significant tendency to lower rates of IOP and positive CRM as well as lower rate of LR in the ELAPE group. Long-term survival and adverse events did not differ between the groups. ELAPE is beneficial for the surgeon in offering better vicinity to the perineal area and better work ergonomics. These technical aspects and the clinically very important tendency to lower rate of LR support the use of ELAPE technique in spite of the lack of survival benefit.

Extralevator abdominoperineal excision versus abdominoperineal excision for low rectal cancer

“…Pooled data from nine studies [14,17,23,26–30,32] that reported operating time showed significantly longer operating time for ELAPE than APE (MD = 57.05, 95% CI = 28.61–85.48, P < 0.001, Table 2) with high heterogeneity ( P < 0.001, I 2 = 90%). The subgroup analysis revealed ELAPE has longer operating time in Europe ( P < 0.001, I 2 = 87%), and no significant statistically difference in Asia ( P = 0.13, I 2 = 92%).…”

“…Pooled data from eight studies [14,15,17,23,26,27,29,32] that reported estimated blood loss showed lower blood loss for ELAPE than APE (MD = −82.98, 95% CI = −122.06 to −43.90, P < 0.001, Table 2) with high heterogeneity ( P < 0.001, I 2 = 72%). The subgroup analysis revealed ELAPE has lower blood loss in Europe ( P = 0.002, I 2 = 59%) and Asia ( P = 0.008, I 2 = 59%).…”

“…The LR rate was reported by 13 studies [14,17,18,23–26,28–30,32–34] (ELAPE group, n = 727; APE group, n = 682). Fixed-effect model analysis revealed significantly lower LR rate for ELAPE than APE (8.8% vs. 20.5%, OR = 0.29, 95% CI = 0.21–0.41, P < 0.001, Table 2) with lower heterogeneity ( P = 0.31, I 2 = 13%, Figure 7), which was inconsistent with a high quality meta-analysis by Negoi et al .…”

“…Third, their lack of standardization of surgical techniques and indications was also unacceptable. Moreover, two studies from Europe [17,23] and the only RCT, from China [26] investigating advanced low rectal cancer showed the perforation is most often located anteriorly; this observation should be considered in surgical plans. Several factors, including the body mass index, tumor stage, and pre-operative therapies, also have been proven to affect the CRM positivity rate.…”

Selection and Outcomes in Abdominoperineal Resection

“…They noted significantly better circumferential margin status in the ELAPR group, with no difference in intraoperative tumor perforation or other complications (32). Additionally, Carpelan et al compared their APR cohort (27 patients, years 2004-2009) with ELAPR patients (42 patients, years 2009-2016) and noted no significant differences between the groups (33). There was, however a trend toward improved circumferential margin, decreased intraoperative perforation and lower rates of local recurrence in the ELAPR cohort.…”