Short-term outcome of extra-levator abdominoperineal excision for rectal cancer

Stelzner, Sigmar; Hellmich, Gunter; Schubert, Clemens; Puffer, E; Haroske, G.; Witzigmann, Helmut

doi:10.1007/s00384-011-1157-0

Cited by 53 publications

(45 citation statements)

References 45 publications

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“…We have shown in this study, a significant reduction in perforation rates in accordance with those reported after ELAPE in the literature [11,26]. The perforation rate of 20.5 % in SAPE is higher than in other reports [29,30,32]. In the ELAPE group, the rate of 7.4 % is comparable to what others have reported [26].…”

Section: Discussionsupporting

confidence: 80%

Extralevator versus standard abdominoperineal excision for rectal cancer

Perdawood

Lund

2014

Tech Coloproctol

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We found low rates of positive CRM after APE compared with the literature. ELAPE did not reduce these rates, and although the local recurrence rate was lower, this did not reach statistical significance. ELAPE has significantly reduced the rate of intraoperative bowel perforation and can optimize low rectal cancer surgery in selected patients. We found no significant differences between the two procedures regarding wound-related complications. A tailored approach and a larger trial with longer follow-up are needed to evaluate long-term results.

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Section: Discussionsupporting

confidence: 80%

Extralevator versus standard abdominoperineal excision for rectal cancer

Perdawood

Lund

2014

Tech Coloproctol

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“…This procedure has been associated with a lower rate of IOP and positive CRM. 7 However, the results from West et al 6 and Asplund et al 8 showed that there was a higher rate of postoperative complications, including perineal wound healing complications, after ELAPE compared to conventional APE procedure. Subsequently, a ELAPE dissecting along the outer plane of levator and keeping the ischiorectal tissue in the perineum phase was proposed by an expert panel of surgeons, radiologists and pathologists.…”

Section: Introductionmentioning

confidence: 95%

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

Shen

Zhang

et al. 2015

European Journal of Surgical Oncology (EJSO)

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“…Those for ELAPER are 7-17% and 3.5-13%, respectively. Studies comparing these two surgical techniques are divided, with some of them clearly showing the superiority of ELAPER over APER for CRM involvement (13,15), whereas others having failed to demonstrate the same (12,(20)(21)(22). Only one randomized trial did show significantly lower rates of local recurrence with ELAPER.…”

Section: Discussionmentioning

confidence: 99%

“…This procedure aims to create a cylindrical specimen without a "waist" so as to reduce the rate of intra operative tumor perforation and CRM positivity. Studies comparing APER with ELAPER have yielded conflicting results (12)(13)(14)(15). There is only one randomized control trial that found a lower rate of local recurrence without an increase in complications with ELAPER (16).…”

Section: Introductionmentioning

confidence: 99%

Selective extra levator versus conventional abdomino perineal resection: experience from a tertiary-care center

Pai

Patil

Arya

et al. 2016

J. Gastrointest. Oncol.

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Background: To compare extra levator abdomino perineal resection (ELAPER) with conventional abdominoperineal resection (APER) in terms of short-term oncological and clinical outcomes.Methods: This is a retrospective review of a prospectively maintained database including all the patients of rectal cancer who underwent APER at Tata Memorial Center between July 1, 2013, and January 31, 2015.Short-term oncological parameters evaluated included circumferential resection margin involvement (CRM), tumor site perforation, and number of nodes harvested. Peri operative outcomes included blood loss, length of hospital stay, postoperative perineal wound complications, and 30-day mortality. The χ 2 -test was used to compare the results between the two groups.Results: Forty-two cases of ELAPER and 78 cases of conventional APER were included in the study.Levator involvement was significantly higher in the ELAPER compared with the conventional group; otherwise, the two groups were comparable in all the aspects. CRM involvement was seen in seven patients (8.9%) in the conventional group compared with three patients (7.14%) in the ELAPER group. Median hospital stay was significantly longer with ELAPER. The univariate analysis of the factors influencing CRM positivity did not show any significance.Conclusions: ELAPER should be the preferred approach for low rectal tumors with involvement of levators. For those cases in which levators are not involved, as shown in preoperative magnetic resonance imaging (MRI), the current evidence is insufficient to recommend ELAPER over conventional APER. This stresses the importance of preoperative MRI in determining the best approach for an individual patient.

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Short-term outcome of extra-levator abdominoperineal excision for rectal cancer

Abstract: With a significant reduction of the bowel perforation rate and a reduction of circumferential margin involvement and wound abscess formation, ELAPE improves important surrogate parameters for local recurrence rate and survival.

Cited by 53 publications

References 45 publications

Extralevator versus standard abdominoperineal excision for rectal cancer

Extralevator versus standard abdominoperineal excision for rectal cancer

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

Selective extra levator versus conventional abdomino perineal resection: experience from a tertiary-care center

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