Oncologic superiority of extralevator abdominoperineal excision for low rectal cancer

Abstract

Background: Rectal cancer treatment has been dramatically improved during the last two decades in terms of a lower local recurrence rate and prolonged survival. This improvement was achieved mainly due to a better surgical technique (implementation of a total mesorectal excision-TME) and neoadjuvant chemo and radio therapy. A more radical approach to abdominoperineal excision, extralevator abdominoperineal excision technique in the prone Jackknife position, may improve the oncological outcome. The aim of this study is to show our early experience by using extralevator abdominoperineal excision. Methods: Extralevator abdominoperineal excision has been used routinely at Oncology Institute of Vojvodina since 2011. In the last 23 months, we had 11 operations. Clinical and pathological data were obtained from operative protocols, histopathological data and patients’ medical history. Results: An audit of results showed reduced rate of intra-operative perforations and circumferential resection margin involvement. Late postoperative complications have occurred in two patients, sexual dysfunction in one and pelvic pain in the other. The follow up period is too short (min 2 months, max 23 months, median 8 months) for analysis of local recurrence. Conclusion: Extralevator abdominoperineal excision, with the emphasis on the perienal dissection and prone Jackknife position, may help achieve the goals of radical resections for low rectal cancer. This technique could be associated with less intra-operative perforations and circumferential resection margin involvement

Value of protective stoma in rectal cancer surgery

“…During the last two decades there was an increased proportion of sphincter-saving procedures in rectal cancer surgery due to better staging, surgical tech-nique, introduction of staplers and preoperative irradiation [1][2][3][4]. However, this has resulted in an increased number of patients exposed to the risk of anastomotic leakage (AL).…”