Prospective controlled study of the safety and oncological outcomes of ELAPE procure with definitive anatomic landmarks versus conventional APE for lower rectal cancer

Shen, Zhanlong; Ye, Y.; Zhang, X.; Xie, Qin; Yin, Ming; Yang, Xiaodong; Jiang, Kewei; Liang, Bin; Wang, S.

doi:10.1016/j.ejso.2015.01.017

Cited by 32 publications

(31 citation statements)

References 21 publications

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“…This increase in CRM positivity following ELAPE has also been demonstrated by another database review from the Danish Colorectal Cancer Group [11]. In addition, some studies have encouraged caution in the use of ELAPE owing to increased morbidity from the procedure [8]. Asplund et al demonstrated no difference in CRM positivity, survival or local recurrence between ELAPE and standard APR though patients undergoing ELAPE had longer length of stay and more perineal wound complications [15].…”

Section: Discussionmentioning

confidence: 73%

“…Several studies have demonstrated reduced local recurrence in selected groups of patients undergoing ELAPE, albeit with increased rates of complication and increased cost [[5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17]]. The larger perineal defect left following ELAPE may require additional resources to close either with mesh, be that synthetic or biological, or complex plastic surgery [18].…”

Section: Introductionmentioning

confidence: 99%

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Oncological outcomes of abdominoperineal resection for the treatment of low rectal cancer: A retrospective review of a single UK tertiary centre experience

Hussain

Mahmood

Torrance

et al. 2018

Annals of Medicine and Surgery

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BackgroundThe use of abdominoperineal resection (APR) in the management of low rectal cancer has received criticism over high rates of incomplete resection due to tumour involvement at the circumferential resection margin. Extralevator abdominoperineal resection has been advocated as a means of improving complete resection. However, Extralevator abdominoperineal resection can result in increased cost, morbidity and reduced quality of life.This study aims to assess the histological features and long-term outcomes of patients undergoing standard abdominoperineal resection and discusses the potential role of Extralevator abdominoperineal resection in this cohort.MethodA retrospective review of a prospectively maintained database of rectal cancer patients at a single centre. Patients undergoing standard APR were included from 01/06/2007 to 31/05/2012 to allow a minimum 2-year follow-up. Data was collected on age, gender, co-morbidity, pre-operative stage, neo-adjuvant therapy, histology, recurrence and mortality.ResultsSeventy patients were identified (45 (64%) male, median age 67; (range 36–85)). 12 (17.1%) patients had a positive circumferential resection margin; 4 (6.1%) tumours were located anteriorly, 8 (11%) were located posteriorly or laterally and may potentially have been completely resected with extralevator abdomino-perineal resection, Number-needed to treat = 9. Positive circumferential resection margin was more common in advanced tumours (p < 0.001). Local recurrence was more common with positive circumferential resection margins (16.7% Vs 0%, p = 0.027), with no statistically significant difference in 5-year survival, although there was a tendency towards worse survival in these patients.ConclusionPositive circumferential resection margin following APR resulted in significantly increased local recurrence with a trend towards poorer survival outcomes. Extralevator abdomino-perineal resection may have benefited some of these patients with locally advanced tumours and postero-lateral recurrences. However, this has to be balanced against exposing patients to increased risk of adverse events. We would recommend selective use of Extralevator abdominoperineal resection for locally advanced and node-positive tumours although further studies to help refine selection criteria are required with long-term follow-up.

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Section: Discussionmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Oncological outcomes of abdominoperineal resection for the treatment of low rectal cancer: A retrospective review of a single UK tertiary centre experience

Hussain

Mahmood

Torrance

et al. 2018

Annals of Medicine and Surgery

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“…To resolve these problems and improve patient survival, ELAPE emerged and proven to effectively reduce CRM involvement and bowel performation[15, 16]. However, there were also researches showed that ELAPE not always reduces CRM positivity [17].…”

Section: Discussionmentioning

confidence: 99%

Extralevator abdominoperineal excision for rectal cancer with biological mesh for pelvic floor reconstruction

Jiang

Wang

et al. 2016

Oncotarget

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GoalTo share our experience of extra-levator abdominoperineal excision (ELAPE) for low rectal cancer, focusing on perineal repair with biological mesh.MethodsWe retrospectively analyzed medical records of all patients with low rectal cancer who underwent the ELAPE procedure using biological mesh for perineal repair at the Gastrointestinal Surgery of Nanjing Drum Power Hospital between January 2013 and September 2015. All patients were closely followed up to now.ResultsA total of 17 patients underwent ELAPE for low rectal cancer was screened. Of these, 15 patients had primary rectal cancer, 1 had local recurrent rectal cancer, and 1 had malignant melanoma. All patients underwent ELAPE successfully without intestinal perforation and got stage I healing in perineum wound without incision infection, dehiscence, cystocele perinealis, urethral dysfunction or intestinal obstruction. Perineum wound hematoma developed in just one patient and had successful percutaneous drainage in one week. During the follow-up, there was no recurrence, perineal hernia, sexual dysfunction, urinary retention, or bowel obstruction. Two patients described slight pain in the sacrococcygeal region without special handling.ConclusionELAPE is applicable to low rectal cancer. Biological mesh reconstruction of perineal defect seems to be safe and effective, with high patient compliance.

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“…Reconstruction of the perineum after extralevator excision is a challenge. When compared with standard APR, a larger tissue deficit is created in the pelvis leading to increased perineal wound healing complications , and often requiring the use of locoregional flaps to fill dead space in the pelvis. A high rate of neoadjuvant chemoradiation therapy in this patient population further increases wound‐healing difficulties by compromising the microvasculature of nearby tissues.…”

Section: Discussionmentioning

confidence: 99%

Novel technique of robotic extralevator abdominoperineal resection with gracilis flap closure

Sieffert

Ouellette

Johnson

et al. 2016

Robotics Computer Surgery

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Prospective controlled study of the safety and oncological outcomes of ELAPE procure with definitive anatomic landmarks versus conventional APE for lower rectal cancer

Cited by 32 publications

References 21 publications

Oncological outcomes of abdominoperineal resection for the treatment of low rectal cancer: A retrospective review of a single UK tertiary centre experience

Oncological outcomes of abdominoperineal resection for the treatment of low rectal cancer: A retrospective review of a single UK tertiary centre experience

Extralevator abdominoperineal excision for rectal cancer with biological mesh for pelvic floor reconstruction

Novel technique of robotic extralevator abdominoperineal resection with gracilis flap closure

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