Abstract
Background
Transperineal abdominoperineal excision (TpAPE) is an emerging approach for low rectal cancers but is technically challenging. Based on an anatomical study we conducted previously, we have standardized the TpAPE procedure. Here, we aimed to validate the feasibility of the standardized TpAPE by investigating the short-term outcomes.
Methods
From January 2018 to November 2020, a total of 405 patients underwent laparoscopic or robotic rectal resection for rectal cancer in our institution. For the current study, we analyzed data for the 31 patients who underwent TpAPE. The abdominal phase was performed synchronously with the perineal phase using either a laparoscopic or robotic approach. Short-term outcomes included operative and pathological results.
Results
Of the 31 cases, we identified anterior quadrant tumor invasion in 21. Most of the cases were advanced, with 6 staged as cT3 and 20 as T4. Of the 27 cases not involving distant metastasis, neoadjuvant therapy was performed in 19. No inadvertent rectal perforation or urethral injury was found intraoperatively. The median procedural duration to specimen removal was 250 min (interquartile range, 204–287), and the median intraoperative blood loss was 10 ml (interquartile range, 5–40). Regarding postoperative complications, perineal wound infection developed in 11 cases. A positive circumferential resection margin was found in 3, corresponding to the positive rate of 9.7%. These three cases were among the first 12 cases involving standardized TpAPE.
Conclusions
The current results indicate that TpAPE can be performed safely and might represent a useful option for low rectal cancer resection.
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Atsushi Hamabe: project development, data collection and analysis, and manuscript writing. Kenji Okita: project development, data analysis, and manuscript editing. Toshihiko Nishidate: project development and data analysis. Koichi Okuya: project development, data collection and analysis, and manuscript editing. Emi Akizuki: project development and data analysis. Yu Sato: project development and manuscript editing. Masayuki Ishii: project development, data collection and analysis, and manuscript writing. Ryo Miura: project development and data collection. Takahiro Korai: project development and collection. Ichiro Takemasa: project development, data analysis, and manuscript editing.
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Hamabe, A., Okita, K., Nishidate, T. et al. Short-Term Outcomes with Standardized Transperineal Minimally Invasive Abdominoperineal Excision for Rectal Cancer. J Gastrointest Surg 26, 713–719 (2022). https://doi.org/10.1007/s11605-021-05140-9
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DOI: https://doi.org/10.1007/s11605-021-05140-9