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Local recurrence after 'standard' abdominoperineal resection: do we really need ELAPE?
A Xanthis1, D Greenberg2, B Jha2
1Colorectal Unit, Addenbrooke's Hospital , Cambridge , UK.
Annals of the Royal College of Surgeons of England
|October 13, 2017
Summary
Standard abdominoperineal resection for low rectal cancer showed low local recurrence rates, even with a 16.6% positive circumferential resection margin. Extralevator abdominoperineal excision may benefit selected patients but isn't universally needed.
Area of Science:
- Colorectal Surgery
- Surgical Oncology
- Rectal Cancer Treatment
Background:
- Low rectal cancers often require abdominoperineal resection (APR), which can be associated with poorer prognoses compared to higher tumors.
- Standard APR may lead to inadequate local surgery and positive circumferential resection margins (CRM).
- Extralevator abdominoperineal excision (ELAPE) aims to improve R0 resection rates but has significant morbidity.
Purpose of the Study:
- To evaluate the outcomes of standard abdominoperineal resection for rectal cancer.
- To assess the need for policy changes regarding surgical techniques for low rectal cancers.
Main Methods:
- Retrospective analysis of 102 consecutive standard APRs for rectal cancer.
- Data collected from June 2002 to December 2011.
- Analysis included preoperative treatment, CRM status, recurrence rates, and survival.
Main Results:
- 16.6% of patients had a positive CRM.
- Median follow-up was 32 months, with 17.7% experiencing any recurrence.
- Two-year local-only recurrence was 3.4%, and five-year cancer-specific survival was 77%.
Conclusions:
- Standard APR demonstrated low local recurrence rates in this series, despite a notable CRM positivity rate.
- ELAPE might offer further improvements for select patients but may not be necessary for all.
- Current surgical policies for standard APR may be adequate for many low rectal cancer cases.
