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Annals of Surgical Oncology

, Volume 22, Issue 9, pp 2997–3006 | Cite as

Standard Versus Extralevator Abdominoperineal Low Rectal Cancer Excision Outcomes: A Systematic Review and Meta-analysis

  • Paola De Nardi
  • Valeria Summo
  • Andrea Vignali
  • Giovanni Capretti
Colorectal Cancer

Background

The extended, extralevator abdominoperineal excision has been described with the aim of improving oncological low rectal cancer patient outcomes.

Materials and Methods

A systematic literature review was conducted using Medline/PubMed, Embase, Cochrane library, and Ovid for standard and extralevator abdominoperineal rectal cancer excision studies between 1995 and 2013. A total of 1,270 articles were identified and screened, and of these, 58 reports (1 randomized, 5 case–control and 52 cohort studies) were included for the qualitative analysis, and 6 were included for the quantitative analysis. The primary endpoints included intraoperative tumor perforation, the circumferential resection margin involvement, local recurrence rate, and the perineal wound complication rate. The secondary endpoints included the length of postoperative hospital stay and quality of life. Comprehensive Rev Men, version 5.2 was used for the statistical calculations.

Results

A significant difference in the circumferential resection margin involvement rate [odds ratio (OR) 2.9; p < .001], intraoperative perforation (OR 4.30; p < .001), local recurrence rate (OR 2.52; p = .02), and length of hospital stay (OR 1.06; p < .001) in favor of the extended group was observed. Additionally, the perineal wound complications were higher in the extended group (OR 0.62; p = .007). No difference in quality of life was observed.

Conclusions

Our analysis confirms the oncological advantages of the extended abdominoperineal excision method. Although the perineal wound complications were higher, the length of postoperative hospital stay was shorter, and quality of life was not inferior to the conventional resection method.

Keywords

Total Mesorectal Excision Circumferential Resection Margin Circumferential Resection Margin Involvement Perineal Wound Complication Perineal Wind Complication 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosure

The Authors have no commercial interest and have no financial support for the present study.

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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Paola De Nardi
    • 1
  • Valeria Summo
    • 1
  • Andrea Vignali
    • 1
  • Giovanni Capretti
    • 1
  1. 1.Department of SurgerySan Raffaele Scientific InstituteMilanItaly

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