Short-term advantages of ELAPE over APR

Papp, Géza; Dede, Kristóf; Bursics, Attila

doi:10.1080/00015458.2020.1778265

Cited by 4 publications

(6 citation statements)

References 24 publications

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“…Many comparative studies report heterogeneous rates of CRM positivity (4.1% -17% for ELAPE, and 10.6% -20% for APE) with and without statistical significance [10,[16][17][18]. In this study, CRM positivity in the APE group is consistent with previously published data.…”

Section: Discussionsupporting

confidence: 90%

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

Ulusoy¹,

Nikolovski

2022

Prilozi

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Aim: To evaluate the effect of extralevator abdominoperineal excision of the rectum (ELAPE) on the circumferential resection margin (CRM) and overall survival in comparison to standard abdominoperineal excision of the rectum (APE) in patients with advanced rectal cancer. Material and Methods: This retrospective study encompasses patients with advanced rectal cancer operated on with two different methods: prone Jack-Knife position ELAPE and APE. In part of them, neoadjuvant chemoradiation was conducted. Postoperative patient, tumor, and outcome data were analyzed in terms of differences in CRM positivity and overall survival. Results: Of 67 patients treated with either APE (52) or ELAPE (15), 43 were male and 24 were female. Neoadjuvant treatment was conducted on 49 of the total patients. Complete pathological response (T0) was achieved in 3 patients. Positive CRM was reported in 7 patients (11.5 %), 3 in ELAPE and 4 in APE group (p = 0.348). The overall postoperative complication rate was 56.7%. Mean survival period was 42.2 months. Overall survival rate for both groups was 67.2 %. No statistical differences were seen between the ELAPE and APE procedure in terms of overall survival (p = 0.483). Conclusions: Differences between the use of ELAPE and APE in terms of CRM positivity and overall survival were not statistically significant. Therefore, we conclude that ELAPE is not superior to standard APE in the treatment of advanced rectal cancer.

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Section: Discussionsupporting

confidence: 90%

“…Perineal wound site adverse events also differ in the studies with wide range of the reported rates, from 8.3% to 37% for ELAPE and from 12.3% to 37.1% for standard APE [18][19][20][21]. This study reports one perineal wound break-down in the ELAPE group and no statistical differences in perineal wound infection rates in the groups.…”

Section: Discussionmentioning

confidence: 64%

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

Ulusoy¹,

Nikolovski

2022

Prilozi

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Section: Discussionmentioning

confidence: 99%

“…This in turn may lead to more local exudation. 10 Additionally, SSI will extend the length of hospital stay, increase the readmission rate, and increase the difficulty and cost of home care. 21 In the present study, we demonstrated that continuous negative pressure drainage combined with intermittent irrigation could reduce the rate of SSI after laparoscopic ELAPE from 35.8% to 17.4%, and no patient had pelvic floor hernia or intestinal rupture during the negative pressure irrigation.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 A latest study reported that the rates of SSI after ELAPE was 26.3%. 10 In addition, preoperative radiotherapy and/or chemotherapy are often required for patients with low rectal cancer, which may also affect the healing of the surgical incision and increase the risk of SSI to approximately 31%. 3,11 The incidence of SSI is associated with prolonged hospital stay and increased medical costs.…”

Section: Introductionmentioning

confidence: 99%

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Continuous Negative Pressure Drainage with Intermittent Irrigation Leaded to a Risk Reduction of Perineal Surgical Site Infection Following Laparoscopic Extralevator Abdominoperineal Excision for Low Rectal Cancer

Han

Yang

Wang

et al. 2021

TCRM

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Purpose High rate of perineal surgical site infection (SSI) is the most common complication following abdominoperineal resection (APR), especially for extralevator abdominoperineal excision (ELAPE). The purpose of this study was to investigate the effect of continuous negative pressure drainage combined with intermittent irrigation (CNPDCII) in the presacral space on the perineal SSI following laparoscopic ELAPE for low rectal cancer. Patients and Methods The clinical data of 99 patients with low rectal cancer who underwent laparoscopic ELAPE surgery were retrospectively analyzed. Among the 99 patients, 46 patients received CNPDCII and 53 patients received conventional drainage in the presacral space after ELAPE. Self-made irrigation drainage tube: took a silicone drainage tube, cut 3 side holes at every 2cm intervals at the front end, and fixed a flexible tube of an intravenous needle at the front end of the silicone drainage tube. The conventional drainage tube or self-made irrigation drainage tube was placed in the presacral space and poked out from the inside of the ischial tuberosity. The incidence of SSI and other perioperative indicators between the two groups was compared within 30 days after surgery. Results There was no statistical difference in clinicopathological features between the two groups of patients (p>0.05). A statistically lower rate of SSI was found in CNPDCII group (17.4%, 8/46) than the conventional drainage group (35.8%, 19/53). The drainage tube retention time (7.8±1.2 d VS 9.4±1.6 d) and the postoperative hospital stay (9.7±1.4 d VS 11.9±2.3 d) in CNPDCII group were significantly shortened than the conventional drainage group. There was no statistical difference in operating theatre time and intraoperative blood loss between the two groups. Multivariate analysis confirmed that CNPDCII was an independent protective factor for SSI after ELAPE. Conclusion CNPDCII can effectively reduce the incidence of SSI following laparoscopic ELAPE, which is simple, safe and effective.

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Negative pressure wound management in perineal wound status post abdominoperineal resection and extralevator abdominoperineal excision: a meta-analysis and trial sequential analysis

Fan

Chen

Jhou

et al. 2023

Int J Colorectal Dis

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Purpose: Recent evidence-based publications disclosed that negative pressure wound therapy (NPWT) may reduce the incidence rate of surgical site infection and length of hospital stay compared with conventional drainage in patient status post abdominoperineal resection (APR) and extralevator abdominoperineal excision (ELAPE). Methods:Data sources: Eligible randomized controlled trials, retrospective and prospective studies published before June 2021 were retrieved from databases(Cochrane Library, PubMed, and Embase).Study selection: (a) the study involved patients undergoing ELAPE or APR with postoperative NPWT; (b) the study compared NWPT with conventional drainage and reported at least one outcome of interest (i.e., SSI); and (c) the study provided adequate information to calculate the effect estimated for meta-analysis.Interventions: We calculated the odds ratio (ORs) and mean differences (MDs) with 95% con dence intervals (CIs).Main outcome measures: The measure outcomes included SSI and LOS.Results: Eight articles, involving 547 patients, met the selection criteria. Compared to conventional drainage, NPWT was associated with a signi cantly lower SSI rate ( xed-effect, OR 0.29; 95% CI 0.18-0.45; I 2 = 0%) in eight studies and 547 patients. Besides, NPWT was associated with a shorter LOS ( xedeffect, MD −2.00; CI −2.60 to −1.39; I 2 = 0%) than conventional drainage in three studies and 305 patients.In a trial sequential analysis, the cumulative number of patients in the analyses of both outcomes exceeded the required information size and surpassed the significance boundary in favor of NPWT, suggesting conclusive results. Conclusion: NPWT is superior to conventional drainage in both SSI rate and LOS, and the statistical power of SSI and LOS are con rmed by trial sequential analysis.

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Short-term advantages of ELAPE over APR

Cited by 4 publications

References 24 publications

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

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

Continuous Negative Pressure Drainage with Intermittent Irrigation Leaded to a Risk Reduction of Perineal Surgical Site Infection Following Laparoscopic Extralevator Abdominoperineal Excision for Low Rectal Cancer

Negative pressure wound management in perineal wound status post abdominoperineal resection and extralevator abdominoperineal excision: a meta-analysis and trial sequential analysis

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