International Journal of Colorectal Disease

, Volume 31, Issue 10, pp 1729–1737 | Cite as

Long-term outcome of extralevator abdominoperineal excision (ELAPE) for low rectal cancer

  • Sigmar StelznerEmail author
  • Gunter Hellmich
  • Anja Sims
  • Thomas Kittner
  • Eric Puffer
  • Joerg Zimmer
  • Dorothea Bleyl
  • Helmut Witzigmann
Original Article



Extralevator abdominoperineal excision (ELAPE) was introduced to improve outcomes for low-lying locally advanced rectal cancers (LARC) not amenable to sphincter preserving procedures. This study investigates prospectively outcomes of patients operated on with ELAPE compared with a similar cohort of patients operated on with conventional APE.


After the exclusion of patients without neoadjuvant therapy, in-hospital mortality, and incomplete metastatectomy, we identified 72 consecutive patients who had undergone either conventional APE (n = 36) or ELAPE (n = 36) for LARC ≤6 cm from the anal verge. The primary outcome measure was local recurrence at 5 years, and secondary outcome measures were cause-specific and overall survival.


Median distance from the anal verge was significantly lower in the ELAPE group (2 vs. 4 cm, p = 0.029). Inadvertent bowel perforation could be completely avoided in the ELAPE group, but amounted to 16.7 % in the conventional APE group (p = 0.025). Cumulative local recurrence rate at 5 years was 18.2 % in the APE group compared to 5.9 % in the ELAPE group (p = 0.153). Local recurrence without distant metastases occurred in 15.5 % in the APE group but was not observed in the ELAPE group (p = 0.039). We did not detect significant differences in cause-specific nor in overall survival.


ELAPE results in lower local recurrence rates as compared with conventional APE. We conclude that the extralevator approach should be the procedure of choice for advanced low rectal cancer not amenable to sphincter preserving procedures.


Abdominoperineal excision Extralevator Rectal cancer Local recurrence Survival Surgery 



The maintenance of the database at the Coloproctologic Unit of Dresden-Friedrichstadt General Hospital is supported by a grant of the Tumor Center Dresden.

Compliance with ethical standards


All authors declare no conflicts of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Sigmar Stelzner
    • 1
    Email author
  • Gunter Hellmich
    • 1
  • Anja Sims
    • 1
  • Thomas Kittner
    • 2
  • Eric Puffer
    • 3
  • Joerg Zimmer
    • 4
  • Dorothea Bleyl
    • 5
  • Helmut Witzigmann
    • 1
  1. 1.Department of General and Visceral SurgeryDresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of DresdenDresdenGermany
  2. 2.Department of RadiologyDresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of DresdenDresdenGermany
  3. 3.Institute of PathologyDresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of DresdenDresdenGermany
  4. 4.Department of Radiation OncologyDresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of DresdenDresdenGermany
  5. 5.Department of OncologyDresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of DresdenDresdenGermany

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