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A tailored approach to abdominoperineal resection for rectal cancer: multicentre analysis of short-term outcomes and impact on oncological survival

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Abstract

Purpose

Abdominoperineal resection of the rectum has evolved over the last century, with few modifications until 2007, when extralevator abdominoperineal resection was introduced, which improved local disease control but resulted in a significant rise in perineal complications. We adopted a modified approach in which dissection was tailored according to magnetic resonance-defined tumour involvement. The aim of this study was to assess short-term and long-term oncological outcomes following a tailored abdominoperineal resection (APR) approach.

Methods

This study was a retrospective review of prospectively maintained databases at three centres: Portsmouth NHS Trust (UK), Poole General Hospital (UK) and Champalimaud’s Cancer Foundation, Portugal. The study included consecutive patients who underwent abdominoperineal resection from October 2008 until April 2018 under the supervision of the senior author. Oncological outcomes, including overall survival and disease-free survival, were used as the main outcome measures.

Results

A total of 584 patients underwent rectal cancer surgery during the study period. The APR ratio was 65/584 (11%). The median age was 66 years. Neoadjuvant treatment was administered to 74% of patients. Of the patients, 91% underwent surgery via a minimally invasive approach. The median hospital stay was 7 days. Patients were followed up for a median of 41 months. Only four patients had positive resection margins. The 5-year overall and disease-free survival rates were 64% and 62%, respectively.

Conclusion

Our data suggest that tailored APR has similar short-term and long-term oncological outcomes compared with extralevator abdominoperineal resection but reduced perineal wound complications. We believe this approach could be a safe alternative but recommend a larger sample size to accurately assess its effectiveness.

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Author information

Authors and Affiliations

  1. Colorectal Surgery, North West Anglia NHS Foundation Trust, Peterborough, PE3 9GZ, UK

    Muhammad Tayyab

  2. Pennine Acute Hospitals NHS Trust, Manchester, UK

    H. Zaidi

  3. Digestive Cancer Unit, Champalimaud Clinical Centre – Champalimaud Foundation, Avenida Brasília, Lisbon, PT, Portugal

    P. Vieira, N. Figueiredo & A. Parvaiz

  4. Poole Hospital NHS Foundation Trust, Poole, UK

    T. Qureshi & A. Parvaiz

Authors
  1. Muhammad Tayyab
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  2. H. Zaidi
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  3. P. Vieira
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  4. T. Qureshi
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  5. N. Figueiredo
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  6. A. Parvaiz
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Contributions

Muhammad Tayyab: conception, data collection/analysis, writing of the paper. Hammad Zaidi FRCS: conception, data collection/analysis, writing of the paper. Pedro Vieira MD: conception, data collection/analysis, writing of the paper. Tahseen Qureshi: conception, data collection/analysis, writing of the paper. Nuno Figueiredo: conception, data collection/analysis, writing of the paper. Amjad Parvaiz MD, FRCS: conception, data collection/analysis, writing of the paper, supervision.

Corresponding author

Correspondence to Muhammad Tayyab.

Ethics declarations

There are no conflicts of interest from any authors. Local institution ethical approval was obtained prior to data collection. The project did not require informed consent from patients, as no confidential information was used.

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Tayyab, M., Zaidi, H., Vieira, P. et al. A tailored approach to abdominoperineal resection for rectal cancer: multicentre analysis of short-term outcomes and impact on oncological survival. Langenbecks Arch Surg 406, 813–819 (2021). https://doi.org/10.1007/s00423-021-02122-y

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  • DOI: https://doi.org/10.1007/s00423-021-02122-y

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