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

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgments

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

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Authors and Affiliations

  1. Department of General and Visceral Surgery, Dresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of Dresden, Friedrichstr. 41, D-01067, Dresden, Germany

    Sigmar Stelzner, Gunter Hellmich, Anja Sims & Helmut Witzigmann

  2. Department of Radiology, Dresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of Dresden, Friedrichstr. 41, D-01067, Dresden, Germany

    Thomas Kittner

  3. Institute of Pathology, Dresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of Dresden, Friedrichstr. 41, D-01067, Dresden, Germany

    Eric Puffer

  4. Department of Radiation Oncology, Dresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of Dresden, Friedrichstr. 41, D-01067, Dresden, Germany

    Joerg Zimmer

  5. Department of Oncology, Dresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of Dresden, Friedrichstr. 41, D-01067, Dresden, Germany

    Dorothea Bleyl

Authors
  1. Sigmar Stelzner
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Correspondence to Sigmar Stelzner.

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Stelzner, S., Hellmich, G., Sims, A. et al. Long-term outcome of extralevator abdominoperineal excision (ELAPE) for low rectal cancer. Int J Colorectal Dis 31, 1729–1737 (2016). https://doi.org/10.1007/s00384-016-2637-z

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