Standard Versus Extralevator Abdominoperineal Low Rectal Cancer Excision Outcomes: A Systematic Review and Meta-analysis

Abstract

Our analysis confirms the oncological advantages of the extended abdominoperineal excision method. Although the perineal wound complications were higher, the length of postoperative hospital stay was shorter, and quality of life was not inferior to the conventional resection method.

A pilot randomized study comparing extralevator with conventional abdominoperineal excision for low rectal cancer after neoadjuvant chemoradiation

“…We observed a higher incidence of perineal wound morbidity in the ELAPE arm. Although some earlier reports mention that delayed perineal wound healing is significantly higher after ELAPE than after an APE , a few others report comparable perineal wound morbidity . The uniform use of NCRT in our study would have further contributed to the delayed healing of the perineal wound.…”

“…The lack of statistical significance is probably a result of the small sample size. Whilst two meta-analyses have shown that CRM involvement is significantly reduced after an ELAPE [19,20], two others have shown no significant difference [21,22]. As photography of specimens and independent histopathological evaluation was not performed in these studies, it is not possible to determine the quality of either the ELAPE or the CAPE procedures.…”

The use of a negative pressure wound management system in perineal wound closure after extralevator abdominoperineal excision (ELAPE) for low rectal cancer

“…The high prevalence of perineal wound breakdown after ELAPE results from the wide cavity, the accumulation of fluids, and the effects of preoperative radiotherapy [13][14][15]. Wound morbidity ranges from asymptomatic seroma to a painful non-healing perineal wound.…”

The importance of pathological quality control for rectal surgery

“…Development of more radical techniques for advanced tumours, e.g., extralevator APE has led to improved clinical outcomes in some studies through a reduction in CRM involvement and perforations compared to "conventional" APE surgery [7,21,22] . Extralevator APE involves the removal of the levator ani with the mesorectum and anal sphincters, creating a more cylindrically shaped specimen and thereby providing critical extra tissue around a low rectal tumour [22] .…”