Analysis of outcome using a levator sparing technique of abdominoperineal excision of rectum and anus. Cylindrical ELAPE is not necessary in all patients

G. Ramsay* (Corresponding Author), C. Parnaby, C. Mackay, P. Hanlon, S. Ong, M. Loudon

*Corresponding author for this work

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Aims Abdominoperineal excision of rectum (APE) for cancer has a higher rate of local recurrence with a poorer outcome than stage matched anterior resection. The cylindrical excision (ELAPE) has been advocated to reduce local recurrence. However, this operation has greater morbidity and requires more post operative care. We report our outcomes from a single centre using a levator sparing dissection. Methods All patients undergoing APE from January 2007-June 2011 were evaluated. Case notes operation notes and pathology results were reviewed for complications and staging. Follow-up data for survival and recurrence were obtained from the cancer registry, imaging and from clinic follow up. Results Of all rectal cancers (n = 361), 43 had APE with curative intent. Median age was 67(IQR 59-76). Median tumour height was two centimetres from the dentate line (IQR 1-3.5 cm). Neoadjuvant chemoradiotherapy was given in 98% of APE resections with curative intent. Median post operative hospital stay was 10 days (8-15). At a median follow up of 38 months (IQR30-49) for patients undergoing curative resection, 2 patients (4.6%) had local recurrence and overall mortality was 18.6% (n = 8). Conclusion With adequate neoadjuvant chemoradiotherapy, a levator sparing excision of rectum remains a safe option with less morbidity and perioperative complications than has been described for ELAPE.

Original languageEnglish
Pages (from-to)1219-1224
Number of pages6
JournalEuropean Journal of Surgical Oncology
Volume39
Issue number11
Early online date20 Aug 2013
DOIs
Publication statusPublished - Nov 2013

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Anal Canal
Rectum
Recurrence
Chemoradiotherapy
Rectal Neoplasms
Morbidity
Registries
Dissection
Length of Stay
Neoplasms
Pathology
Survival
Mortality

Keywords

  • Abdomino-perineal resection
  • APER
  • Colorectal
  • ELAPE
  • Outcomes

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

@article{bc5b9460be954a58b20fecb43386c322,
title = "Analysis of outcome using a levator sparing technique of abdominoperineal excision of rectum and anus. Cylindrical ELAPE is not necessary in all patients",
abstract = "Aims Abdominoperineal excision of rectum (APE) for cancer has a higher rate of local recurrence with a poorer outcome than stage matched anterior resection. The cylindrical excision (ELAPE) has been advocated to reduce local recurrence. However, this operation has greater morbidity and requires more post operative care. We report our outcomes from a single centre using a levator sparing dissection. Methods All patients undergoing APE from January 2007-June 2011 were evaluated. Case notes operation notes and pathology results were reviewed for complications and staging. Follow-up data for survival and recurrence were obtained from the cancer registry, imaging and from clinic follow up. Results Of all rectal cancers (n = 361), 43 had APE with curative intent. Median age was 67(IQR 59-76). Median tumour height was two centimetres from the dentate line (IQR 1-3.5 cm). Neoadjuvant chemoradiotherapy was given in 98{\%} of APE resections with curative intent. Median post operative hospital stay was 10 days (8-15). At a median follow up of 38 months (IQR30-49) for patients undergoing curative resection, 2 patients (4.6{\%}) had local recurrence and overall mortality was 18.6{\%} (n = 8). Conclusion With adequate neoadjuvant chemoradiotherapy, a levator sparing excision of rectum remains a safe option with less morbidity and perioperative complications than has been described for ELAPE.",
keywords = "Abdomino-perineal resection, APER, Colorectal, ELAPE, Outcomes",
author = "G. Ramsay and C. Parnaby and C. Mackay and P. Hanlon and S. Ong and M. Loudon",
year = "2013",
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TY - JOUR

T1 - Analysis of outcome using a levator sparing technique of abdominoperineal excision of rectum and anus. Cylindrical ELAPE is not necessary in all patients

AU - Ramsay, G.

AU - Parnaby, C.

AU - Mackay, C.

AU - Hanlon, P.

AU - Ong, S.

AU - Loudon, M.

PY - 2013/11

Y1 - 2013/11

N2 - Aims Abdominoperineal excision of rectum (APE) for cancer has a higher rate of local recurrence with a poorer outcome than stage matched anterior resection. The cylindrical excision (ELAPE) has been advocated to reduce local recurrence. However, this operation has greater morbidity and requires more post operative care. We report our outcomes from a single centre using a levator sparing dissection. Methods All patients undergoing APE from January 2007-June 2011 were evaluated. Case notes operation notes and pathology results were reviewed for complications and staging. Follow-up data for survival and recurrence were obtained from the cancer registry, imaging and from clinic follow up. Results Of all rectal cancers (n = 361), 43 had APE with curative intent. Median age was 67(IQR 59-76). Median tumour height was two centimetres from the dentate line (IQR 1-3.5 cm). Neoadjuvant chemoradiotherapy was given in 98% of APE resections with curative intent. Median post operative hospital stay was 10 days (8-15). At a median follow up of 38 months (IQR30-49) for patients undergoing curative resection, 2 patients (4.6%) had local recurrence and overall mortality was 18.6% (n = 8). Conclusion With adequate neoadjuvant chemoradiotherapy, a levator sparing excision of rectum remains a safe option with less morbidity and perioperative complications than has been described for ELAPE.

AB - Aims Abdominoperineal excision of rectum (APE) for cancer has a higher rate of local recurrence with a poorer outcome than stage matched anterior resection. The cylindrical excision (ELAPE) has been advocated to reduce local recurrence. However, this operation has greater morbidity and requires more post operative care. We report our outcomes from a single centre using a levator sparing dissection. Methods All patients undergoing APE from January 2007-June 2011 were evaluated. Case notes operation notes and pathology results were reviewed for complications and staging. Follow-up data for survival and recurrence were obtained from the cancer registry, imaging and from clinic follow up. Results Of all rectal cancers (n = 361), 43 had APE with curative intent. Median age was 67(IQR 59-76). Median tumour height was two centimetres from the dentate line (IQR 1-3.5 cm). Neoadjuvant chemoradiotherapy was given in 98% of APE resections with curative intent. Median post operative hospital stay was 10 days (8-15). At a median follow up of 38 months (IQR30-49) for patients undergoing curative resection, 2 patients (4.6%) had local recurrence and overall mortality was 18.6% (n = 8). Conclusion With adequate neoadjuvant chemoradiotherapy, a levator sparing excision of rectum remains a safe option with less morbidity and perioperative complications than has been described for ELAPE.

KW - Abdomino-perineal resection

KW - APER

KW - Colorectal

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