Extralevator abdominoperineal resection in the prone position

Area of Science:

• Surgical Oncology
• Colorectal Surgery

Background:

• The Miles operation, a type of abdominoperineal resection, is under scrutiny for its oncologic outcomes.
• Standard abdominoperineal resection is associated with higher rates of circumferential resection margin (CRM) infiltration and tumor perforation compared to anterior resection.
• These poorer outcomes may stem from excessive dissection leading to a "resection waist" effect.

Purpose of the Study:

• To evaluate the oncologic benefits of extraelevator abdominoperineal resection (ELAPE) compared to standard abdominoperineal resection.
• To discuss the impact of patient positioning (prone vs. supine) and surgical approach (laparoscopy) on ELAPE outcomes.
• To highlight the need for further research to optimize surgical techniques for improved rectal cancer treatment.

Main Methods:

• Comparative analysis of surgical techniques for abdominoperineal resection.
• Discussion of patient positioning (prone vs. supine) and its effect on surgical exposure and outcomes.
• Consideration of laparoscopic approaches for the abdominal component of the surgery.

Main Results:

• ELAPE aims to provide a "cylindrical" specimen, potentially reducing CRM infiltration and local recurrence.
• The prone position offers better surgical exposure but lacks proven oncologic superiority over the supine position.
• Laparoscopic approaches show promise but require validation through large prospective studies.

Conclusions:

• While ELAPE offers theoretical advantages for achieving a cylindrical specimen, its oncologic superiority over standard abdominoperineal resection is not yet established.
• Evidence supporting the superiority of prone ELAPE regarding oncologic results, morbidity, and mortality is lacking.
• Prospective, randomized trials are essential to validate ELAPE, patient positioning, and laparoscopic approaches for improved rectal cancer surgery.