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Short-term outcomes of the modified extralevator abdominoperineal resection for low rectal cancer (with videos)

Abstract

Background

Extralevator abdominoperineal resection had oncologic superiority with reduced local recurrence and improving survival rates. However, extended perineal resection resulted in complicated perineal reconstructions. Therefore, a new surgical technique to overcome previous limitations is required. This study aims to demonstrate a surgical procedure and outcomes of the modified extralevator abdominoperineal resection, which satisfies both an extended cylindrical resection and a convenient perineal wound closure by modification of the surgical dissection plane.

Methods

From September 2011 to February 2014, 12 consecutive patients (five males and seven females) who underwent the modified extralevator abdominoperineal resection for low rectal cancer were evaluated. Intraoperative and postoperative outcomes were assessed. Pathologic outcomes were evaluated for the oncologic results.

Results

The mean age was 55.3 ± 15.1 years, and body mass index was 21.8 ± 3.1 kg/m2. Ten patients (83.3 %) received preoperative chemoradiotherapy. The operations were performed by five cases of laparoscopic surgery, six cases of open surgery and one case of robotic surgery. The mean operation time was 258.8 ± 58.0 min. There were no conversions and no tumor perforations. Days to first soft diet was 4.7 ± 3.4 days, and the mean hospital stay was 11.2 ± 4.7 days. Postoperative complications were two cases of grade I, two cases of grade II and one case of grade III. There was one patient (8.3 %) with a positive circumferential resection margin, and there was one case of local recurrence.

Conclusions

The modified extralevator abdominoperineal resection was feasible and safe for patients with low rectal cancer with extended perineal dissection and convenient direct wound closure.

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Acknowledgments

The authors thank MiSun Park (professional editor) for the English revision and Dong-Su Jang, MFA (Medical Illustrator, Yonsei University College of Medicine, Department of Research Affairs) for his help with the illustrations of this manuscript.

Author information

Correspondence to Seung Hyuk Baik.

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Disclosures

Eun Jung Park, Seung Hyuk Baik, Jeonghyun Kang, Hyuk Hur, Byung Soh Min, Kang Young Lee, Nam Kyu Kim, Seung-Kook Sohn have no conflicts of interest or financial ties to disclose.

Additional information

This article was accepted for poster presentation at SAGES 2015 Annual Meeting.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Abdominal phase (WMV 30372 kb)

Perineal phase (WMV 28773 kb)

Perineal wound closure (WMV 26457 kb)

Video 1

Abdominal phase (WMV 30372 kb)

Video 2

Perineal phase (WMV 28773 kb)

Video 3

Perineal wound closure (WMV 26457 kb)

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Park, E.J., Baik, S.H., Kang, J. et al. Short-term outcomes of the modified extralevator abdominoperineal resection for low rectal cancer (with videos). Surg Endosc 30, 1672–1682 (2016). https://doi.org/10.1007/s00464-015-4400-x

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Keywords

  • Rectal cancer
  • Abdominoperineal resection
  • Total mesorectal excision
  • Reconstruction
  • Primary closure