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Oerskov KM, Bondeven P, Laurberg S, Hagemann-Madsen RH, Christensen HK, Lauridsen H, Pedersen BG. Postoperative MRI Findings Following Conventional and Extralevator Abdominoperineal Excision in Low Rectal Cancer. Front Surg 2021; 8:771107. [PMID: 34869567 PMCID: PMC8635027 DOI: 10.3389/fsurg.2021.771107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 10/04/2021] [Indexed: 01/11/2023] Open
Abstract
Aim: The disparity in outcomes for low rectal cancer may reflect differences in operative approach and quality. The extralevator abdominoperineal excision (ELAPE) was developed to reduce margin involvement in low rectal cancers by widening the excision of the conventional abdominoperineal excision (c-APE) to include the posterior pelvic diaphragm. This study aimed to determine the prevalence and localization of inadvertent residual pelvic diaphragm on postoperative MRI after intended ELAPE and c-APE. Methods: A total of 147 patients treated with c-APE or ELAPE for rectal cancer were included. Postoperative MRI was performed on 51% of the cohort (n = 75) and evaluated with regard to the residual pelvic diaphragm by a radiologist trained in pelvic MRI. Patient records, histopathological reports, and standardized photographs were assessed. Pathology and MRI findings were evaluated independently in a blinded fashion. Additionally, preoperative MRIs were evaluated for possible risk factors for margin involvement. Results: Magnetic resonance imaging-detected residual pelvic diaphragm was identified in 45 (75.4%) of 61 patients who underwent ELAPE and in 14 (100%) of 14 patients who underwent c-APE. An increased risk of margin involvement was observed in anteriorly oriented tumors with 16 (22%) of 73 anteriorly oriented tumors presenting with margin involvement vs. 7 (9%) of 74 non-anteriorly oriented tumors (p = 0.038). Conclusion: Residual pelvic diaphragm following abdominoperineal excision can be depicted by postoperative MRI. Inadvertent residual pelvic diaphragm (RPD) was commonly found in the series of patients treated with the ELAPE technique. Anterior tumor orientation was a risk factor for circumferential resection margin (CRM) involvement regardless of surgical approach.
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Affiliation(s)
| | - Peter Bondeven
- Department of Surgery, Randers Regional Hospital, Randers, Denmark
| | - Søren Laurberg
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | | | - Henrik Lauridsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bodil Ginnerup Pedersen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Han Z, Yang C, Wang Q, Wang M, Li X, Zhang C. 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. Ther Clin Risk Manag 2021; 17:357-364. [PMID: 33911871 PMCID: PMC8075358 DOI: 10.2147/tcrm.s306896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/08/2021] [Indexed: 12/28/2022] Open
Abstract
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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Affiliation(s)
- Zhongbo Han
- Department of Gastrointestinal Surgery, Zibo Central Hospital, Shandong University, Zibo, Shandong, People's Republic of China
| | - Chunxia Yang
- Department of Gastrointestinal Surgery, Zibo Central Hospital, Shandong University, Zibo, Shandong, People's Republic of China
| | - Qingfeng Wang
- Department of Gastrointestinal Surgery, Zibo Central Hospital, Shandong University, Zibo, Shandong, People's Republic of China
| | - Meng Wang
- Department of Gastrointestinal Surgery, Zibo Central Hospital, Shandong University, Zibo, Shandong, People's Republic of China
| | - Xi Li
- Department of Gastrointestinal Surgery, Zibo Central Hospital, Shandong University, Zibo, Shandong, People's Republic of China
| | - Chao Zhang
- Department of Gastrointestinal Surgery, Zibo Central Hospital, Shandong University, Zibo, Shandong, People's Republic of China
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Sancho-Muriel J, Ocaña J, Cholewa H, Nuñez J, Muñoz P, Flor B, García JC, García-Granero E, Die J, Frasson M. Biological mesh reconstruction versus primary closure for preventing perineal morbidity after extralevator abdominoperineal excision: a multicentre retrospective study. Colorectal Dis 2020; 22:1714-1723. [PMID: 32619064 DOI: 10.1111/codi.15225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/10/2020] [Indexed: 02/08/2023]
Abstract
AIM The aim of the study was to compare the incidence of perineal hernia and the perineal wound morbidity following extralevator abdominoperineal excision (ELAPE) between two groups - primary perineal closure and reconstruction with a biological mesh. METHOD One hundred and forty-seven consecutive patients who underwent ELAPE for primary rectal cancer between January 2007 and December 2018 in two tertiary referral centres were retrospectively identified from prospective databases. Perineal closure was carried out via primary closure or with a biological mesh (porcine dermal collagen mesh). Outcome measures were perineal hernia and perineal wound morbidity (infection, dehiscence, persistent sinus and chronic pain). RESULTS A total of 139 patients were included in the study. A prophylactic mesh was used in 80 (57.5%) and primary closure was practised in 59 (42.4%) patients. The median follow-up was 30 (interquartile range 46.88) months. Thirty patients (21.6%) developed perineal hernia. No significant differences were found between prophylactic mesh and primary closure (16.3% vs 23.3%, P = 0.07). The median period between surgery and hernia diagnosis was 8 months in the primary closure group and 24 months in the mesh group (P < 0.01). Perineal wound morbidity was significantly higher in the prophylactic mesh group (55% vs 33.9%, P < 0.01). CONCLUSION In our study, the use of a biological mesh did not reduce the rate of perineal hernia, although it did delay its appearance. Perineal closure using a biological mesh may increase perineal morbidity, both acute and chronic.
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Affiliation(s)
- J Sancho-Muriel
- Division of Coloproctology, Department of General and Digestive Surgery, La Fe University Hospital, Valencia, Spain
| | - J Ocaña
- Division of Coloproctology, Department of General and Digestive Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - H Cholewa
- Division of Coloproctology, Department of General and Digestive Surgery, La Fe University Hospital, Valencia, Spain
| | - J Nuñez
- Division of Coloproctology, Department of General and Digestive Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - P Muñoz
- Division of Coloproctology, Department of General and Digestive Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - B Flor
- Division of Coloproctology, Department of General and Digestive Surgery, La Fe University Hospital, Valencia, Spain
| | - J C García
- Division of Coloproctology, Department of General and Digestive Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - E García-Granero
- Division of Coloproctology, Department of General and Digestive Surgery, La Fe University Hospital, Valencia, Spain
| | - J Die
- Division of Coloproctology, Department of General and Digestive Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - M Frasson
- Division of Coloproctology, Department of General and Digestive Surgery, La Fe University Hospital, Valencia, Spain
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Xiao H, Huang R, Li X, Wang Z. Laparoscopic Versus Open Extralevaor Abdominoperineal Excision for Lower Rectal Cancer: A Retrospective Cohort Study in Single Institute. J Laparoendosc Adv Surg Tech A 2020; 31:71-76. [PMID: 32706627 DOI: 10.1089/lap.2020.0352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: To explore the safety and efficacy of laparoscopic extralevator abdominoperineal excision (La-ELAPE) and open extralevator abdominoperineal excision (Op-ELAPE) for patients with lower rectal cancer. Materials and Methods: Consecutive 101 patients with lower rectal cancer who underwent La-ELAPE or Op-ELAPE in our institution from January 2014 and May 2018 were analyzed retrospectively. The patients' clinicopathological data and postoperative outcomes were compared between the two groups. Results: A total of 101 patients were enrolled in the study, 43 (42.6%) patients successfully underwent La-ELAPE and 58 (57.4%) Op-ELAPE. The Op-ELAPE group had more intraoperative blood loss (P = .03), and longer postoperative hospital stay (P = .01) compared with the La-ELAPE group. There were no significant differences between the two group in terms of the operation time (P = .08), circumferential resection margin positivity (P = 1.00), intraoperative perforation (P = .73), and number of positive lymph nodes (P = .91). There were no significant differences in postoperative complications such as colostomy-associated issues (P = .79), intestinal obstruction (P = 1.00), urinary retention (P = 1.00), perineal wound complications (P = .64), and chronic perineal pain (P = .70) between the two groups. According to the Kaplan-Meier survival analysis and log rank test, the overall survival rate and progression-free survival rate between the two groups also showed no significant difference. Conclusion: This study showed that La-ELAPE significantly reduced the intraoperative blood loss and the postoperative hospital stay without increasing postoperative morbidity for patients with lower rectal cancer when compared with Op-ELAPE. It suggests that La-ELAPE is safe and effective for patients with lower rectal cancer. For the experienced endoscopic surgeons, the La-ELAPE might be an alternative surgical treatment.
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Affiliation(s)
- Hui Xiao
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Rui Huang
- Department of Key Laboratory, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Xiangnan Li
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhenjun Wang
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
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Shen Y, Yang T, Deng X, Yang J, Meng W, Wang Z. Pelvic peritoneum reconstruction using the bladder peritoneum flap in laparoscopic extralevator abdominoperineal excision: A multi-center, prospective single-arm cohort study (IDEAL Phase 2A). Medicine (Baltimore) 2020; 99:e20712. [PMID: 32569206 PMCID: PMC7310913 DOI: 10.1097/md.0000000000020712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Extralevator abdominoperineal excision (ELAPE) may cause various surgical complications including disruption of perineal wound, perineal hernia and adhesive small-bowel obstruction. Pelvic peritoneum reconstruction (PPR) could prevent those complications, but it may not always be achievable, especially in patients with severe pelvic fibrosis after neoadjuvant radiotherapy. Our previous study has reported the application of the PPR using the bladder peritoneum flap in laparoscopic ELAPE. The aim of the study is to evaluate the short-term clinical, technical and safety outcomes of PPR using the bladder peritoneum flap in laparoscopic ELAPE. METHODS AND ANALYSIS This is a multi-center prospective single-arm cohort study and fulfill the IDEAL 2A stage principle. Rectal cancer patients undergoing laparoscopic ELAPE, suffering rigid pelvis or huge perineal peritoneum defect, and having difficulty in primary perineal wound closure will be considered eligible. Main exclusion criteria are being complicated with urgent complications, ASA grade >3 and accompanied with mental illness. After informed consent, 30 patients are planned to be included in the study. Standard laparoscopic ELAPE with pelvic peritoneal floor reconstruction using bladder peritoneum flap are to be performed. The surgical safety is to be evaluated after one-year follow-up. Primary endpoints are the occurrence of intraoperative and postoperative complications of PPR using the bladder peritoneum flap. Second endpoints are overall complication rate within 30 days after surgery, extent of small intestine falling down to pelvic cavity, and other follow-up consequences within 1 year after surgery. ETHICS AND DISSEMINATION This experiment was approved by the Biomedical Ethics Committee of West China Hospital of Sichuan University. TRIAL REGISTRATION NCT04177407.
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Affiliation(s)
- Yu Shen
- Department of Gastrointestinal Surgery
| | | | | | - Jinliang Yang
- State Key Lab of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Zhang Y, Wang D, Zhu L, Wang B, Ma X, Shi B, Yan Y, Zhou C. Standard versus extralevator abdominoperineal excision and oncologic outcomes for patients with distal rectal cancer: A meta-analysis. Medicine (Baltimore) 2017; 96:e9150. [PMID: 29384902 PMCID: PMC6393134 DOI: 10.1097/md.0000000000009150] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The role of extralevator abdominoperineal excision (ELAPE) for distal rectal cancer remains controversial, and the procedure is not widely accepted or practiced. METHODS An electronic search of Medline, EMBASE, Web of Science, and similar databases for articles in English was performed from the inception of the study until October 31, 2017. Two reviewers extracted information and independently assessed the quality of included studies by the methodological index for nonrandomized studies, then data were analyzed with Review Manager 5.3 software and Stata version 12.0 software. RESULTS Our meta-analysis included 17 studies with 3479 patients, of whom 1915 (55.0%) underwent ELAPE and 1564 (44.0%) underwent abdominoperineal excision (APE). Compared with patients undergoing APE, patients undergoing ELAPE had a significant reduced risk of no more than 3 years local recurrence (LR) (risk ratio [RR] = 0.27, 95% confidence interval [CI] = 0.08-0.94), 3-year mortality (odds ratio [OR] = 0.45, 95% CI = 0.20-0.97), intraoperative bowel perforation (IBP) involvement (RR = 0.48, 95% CI = 0.31-0.74), and circumferential resection margin (CRM) positivity (RR = 0.66, 95% CI = 0.43-1.00) at the threshold level. CONCLUSIONS The application of ELAPE is more effective in reducing the chance of 3 years LR, mortality, IBP involvement and CRM positivity than conventional APE, and worthy of being widely applied in surgical treatment of the distal rectal cancer.
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Affiliation(s)
- Yunfeng Zhang
- Department of the Second Thoracic Surgery, the First Affiliated Hospital of Xi’an Jiaotong University
| | - Duo Wang
- Department of General Surgery, the Second Affiliated Hospital of Xi’an Medical College
| | - Lizhe Zhu
- Department of Breast Surgery, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Bin Wang
- Department of Breast Surgery, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Xiaoxia Ma
- Department of Breast Surgery, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Bohui Shi
- Department of Breast Surgery, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Yu Yan
- Department of Breast Surgery, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Can Zhou
- Department of Breast Surgery, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
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Seshadri RA, West NP, Sundersingh S. A pilot randomized study comparing extralevator with conventional abdominoperineal excision for low rectal cancer after neoadjuvant chemoradiation. Colorectal Dis 2017; 19:O253-O262. [PMID: 28503808 DOI: 10.1111/codi.13726] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/05/2017] [Indexed: 02/08/2023]
Abstract
AIM The aims of this study were to assess the feasibility of performing an extralevator abdominoperineal excision (ELAPE) after neoadjuvant chemoradiation (NCRT), to compare the rates of circumferential resection margin (CRM) involvement and intra-operative perforation (IOP) of the specimen, and to assess the amount of tissue removed around the muscularis propria (MP)/internal sphincter (IS) of the lower rectum in patients with low rectal cancer undergoing ELAPE compared with conventional abdominoperineal excision (CAPE) after NCRT. METHOD This was an open-label, parallel-arm pilot randomized trial conducted in India. Twenty patients were randomized to one of the study arms. The surgical specimens were fixed, serially cross-sectioned and photographed. Using specialized morphometry software, the amount of tissue resected with each operation was measured. RESULTS There was a nonsignificant trend towards more IOPs (30% vs 0%, P = 0.06) and a higher CRM involvement rate (40% vs 20%, P = 0.32) in the CAPE arm. ELAPE removed a significantly greater amount of tissue around the IS/MP when compared with CAPE (mean ± SD: 1911.39 ± 382 mm2 vs 1132.03 ± 371 mm2 , P < 0.001). The mean distance from the IS/MP to the CRM was significantly greater in the ELAPE arm both in the posterior (mean ± SD: 28.28 ± 3 mm vs 9.63 ± 3 mm, P < 0.001) and lateral (mean ± SD: 13.69 ± 3 mm vs 9.72 ± 3 mm, P = 0.009) parts of the rectum but not in the anterior part (mean ± SD: 6.74 ± 2 mm vs 6.10 ± 4 mm, P = 0.64). The short-term morbidity was not significantly different between the two procedures. CONCLUSION ELAPE removed more tissue in the lower rectum and resulted in a lower rate of IOP and CRM involvement when compared with CAPE, even after NCRT.
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Affiliation(s)
- R A Seshadri
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, India
| | - N P West
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - S Sundersingh
- Department of Oncopathology, Cancer Institute (WIA), Chennai, India
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Bianco F, Romano G, Tsarkov P, Stanojevic G, Shroyer K, Giuratrabocchetta S, Bergamaschi R. Extralevator with vs non extralevator abdominoperineal excision for rectal cancer: the RELAPe randomized controlled trial. Colorectal Dis 2017; 19:148-157. [PMID: 27369739 DOI: 10.1111/codi.13436] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 05/12/2016] [Indexed: 02/08/2023]
Abstract
AIM A randomized controlled trial was conducted to test the null hypothesis that there is no difference in circumferential resection margin (CRM) between extralevator abdominoperineal excision (ELAPE) and non-ELAPE for rectal cancer. METHOD This was a multicentre, randomized controlled trial registered as NCT01702116. Patients with rectal cancer involving the external anal sphincter were randomized to ELAPE or non-ELAPE following neoadjuvant chemoradiation. Randomization was performed according to Consolidated Standards of Reporting Trials (CONSORT) guidelines. The primary end-point was CRM (in mm), defined as the shortest distance between the tumour and the cut edge of the specimen. Pathologists and centralized pathology were blinded to the patients' study arm. Interrater reliability (IRR) was assessed using Kendall's coefficient. Intra-operative perforation (IOP) was any rectal defect determined at pathology. Complications were classified using the Clavien-Dindo classification. Participating surgeons were retrained and credentialed. A sample size calculation showed that 34 subjects would provide sufficient power to reject the null hypothesis. RESULTS Thirty-four patients underwent the allocated intervention. Seventeen patients treated with ELAPE were comparable with 17 patients treated with non-ELAPE regarding age, gender, body mass index (BMI), American Society of Anesthesiology (ASA) class and pre-existing comorbidities. CRM depth (7.14 ± 5.76 mm vs 2.98 ± 3.28 mm, P = 0.016) and involvement rates (5.8% vs 41.0%, P = 0.04) were significantly increased in patients treated with ELAPE. The IRR for CRM was 0.78. There were no significant differences in IOP (5.8% vs 11.7%, P = 0.77) and complication rates (29% vs 29%, P = 0.97). CONCLUSIONS ELAPE was associated with statistically improved CRM with no difference in IOP and complication rates compared with non-ELAPE for rectal cancer involving the external anal sphincter.
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Affiliation(s)
- F Bianco
- Division of Colorectal Surgery, State University of New York, Stony Brook, New York, USA.,Department of Colorectal Surgery, National Cancer Institute, Naples, Italy
| | - G Romano
- Department of Colorectal Surgery, National Cancer Institute, Naples, Italy
| | - P Tsarkov
- Department of Colorectal Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - G Stanojevic
- Department of Colorectal Surgery, School University of Niš, Niš, Serbia
| | - K Shroyer
- Department of Pathology, State University of New York, Stony Brook, New York, USA
| | - S Giuratrabocchetta
- Division of Colorectal Surgery, State University of New York, Stony Brook, New York, USA
| | - R Bergamaschi
- Division of Colorectal Surgery, State University of New York, Stony Brook, New York, USA
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Yang Y, Xu H, Shang Z, Chen S, Chen F, Deng Q, Luo L, Zhu L, Shi B. Outcome of extralevator abdominoperineal excision over conventional abdominoperineal excision for low rectal tumor: a meta-analysis. Int J Clin Exp Med 2015; 8:14855-14862. [PMID: 26628967 PMCID: PMC4658856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/14/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE A meta-analysis was undertaken to provide an evidence-based basis of clinical trials comparing extralevator abdominoperineal excision with conventional abdominoperineal excision for low rectal tumor. METHODS We searched through the major medical databases such as PubMed, EMBASE, Medline, Science Citation Index, Web of Science for all published studies without any limit on language from January 2009 until January 2015. The following search terms were used: extralevator abdominoperineal excision or cylindrical abdominoperineal resection or conventional abdominoperineal excision or abdominoperineal excision or rectal cancer. Furthermore, Additional related studies were manually searched in the reference lists of all published reviews and retrieved articles. RESULTS In this meta-analysis, there are a total number of 1797 patients included: 1099 patients in the ELAPE group and 698 in the APE group, and there are not statistically differences between groups in CRM [RR=0.65, 95% CI (0.41, 1.04), P=0.07] and wound complications [RR=1.14, 95% CI (1.09, 1.66), P=0.45] between ELAPE and APE. However, ELAPE has a lower rate of intraoperation perforation [RR=0.44; 95% CI (0.33, 0.60); P<0.00001] and local recurrence [RR=0.45, 95% CI (0.27, 0.77), P=0.003] than APE in terms of short follow-up time.
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Affiliation(s)
- Yue Yang
- Department of Surgery, Qilu Hospital of Shandong UniversityWenhua West Road 44#, Jinan 250100, Shandong Province, China
| | - Huirong Xu
- Department of Surgery, Shandong Tumor HospitalJinan 250100, Shandong Province, China
| | - Zhenhua Shang
- Department of Surgery, Qilu Hospital of Shandong UniversityWenhua West Road 44#, Jinan 250100, Shandong Province, China
| | - Shouzhen Chen
- Department of Surgery, Qilu Hospital of Shandong UniversityWenhua West Road 44#, Jinan 250100, Shandong Province, China
| | - Fan Chen
- Department of Surgery, Qilu Hospital of Shandong UniversityWenhua West Road 44#, Jinan 250100, Shandong Province, China
| | - Qiming Deng
- Department of Surgery, Qilu Hospital of Shandong UniversityWenhua West Road 44#, Jinan 250100, Shandong Province, China
| | - Li Luo
- Department of Surgery, Qilu Hospital of Shandong UniversityWenhua West Road 44#, Jinan 250100, Shandong Province, China
| | - Liang Zhu
- Department of Surgery, Qilu Hospital of Shandong UniversityWenhua West Road 44#, Jinan 250100, Shandong Province, China
| | - Benkang Shi
- Department of Surgery, Qilu Hospital of Shandong UniversityWenhua West Road 44#, Jinan 250100, Shandong Province, China
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