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Extralevator vs conventional abdominoperineal resection for rectal cancer-A systematic review and meta-analysis
Ionut Negoi1, Sorin Hostiuc2, Sorin Paun1
1General Surgery Department, Carol Davila University of Medicine and Pharmacy Bucharest, No. 37 Dionisie Lupu Street, Sector 2, 020021, Bucharest, Romania; General Surgery Department, Emergency Hospital of Bucharest, Bucharest, Romania.
Background:
The aim of this study was to compare the short-term morbidity and long-term oncologic benefits of extralevator abdominoperineal excision (ELAPE) with conventional abdominoperineal resection (CAPR) for patients with rectal cancer.
Methods:
Electronic search of the Cochrane Library, MEDLINE, EMBASE, Korean Journal, and J-EAST database from 2007 until August 2015 was carried out. We considered randomized controlled trials and nonrandomized comparative studies comparing ELAPE with CAPR to be eligible, if they included patients with rectal cancers.
Results:
A total of 1 randomized controlled trials and 10 nonrandomized comparative studies met the inclusion criteria, involving 1,736 patients in the ELAPE group and 1,320 in the CAPR group. The ELAPE was associated with a significantly lower intraoperative perforation rate. There were no differences regarding the circumferential margin involvement, R0 resections, and local recurrence rate. There was less blood loss in ELAPE patients.
Conclusions:
The ELAPE significantly lowered the intraoperative perforation rate, with no benefits regarding circumferential resection margin involvement and local recurrence rate.
