Abstract:
Objective: Extralevator abdominoperineal excision (ELAPE) reduces the risk of positive circumferential resection
margin (CRM) and of intraoperative perforation (IOP), both of which are associated with high local recurrence rates
and poor survival outcomes for rectal cancer. The aim of this study was to compare the results of ELAPE with conventional
abdominoperineal excision (APE) for low rectal cancer.
Material and Methods: A total of 25 consecutive patients underwent ELAPE for low rectal cancer between November
2008 and September 2011. Fifty-six patients treated by conventional APE prior to 2008 were selected from our rectal
cancer database for comparison as a historical cohort.
Results: The mean follow-up was 44.7 months in the ELAPE group, and 70.6 months in the APE group. Patients undergoing
ELAPE had a lower CRM positivity and IOP rate than APE (12% vs. 20%, p=0,531; 4% vs. 8,9%, p=0,826; respectively).
The ELAPE group was associated with higher perineal wound complications than the APE group (16.0% vs.
1.8%, p=0.030). Local recurrence rates for patients in both groups did not differ significantly (4.0% vs. 3.6%, p=1.0).
Conclusion: The results of this study suggest that ELAPE technique was associated with less CRM involvement and
reduced rates of IOP but markedly higher rates of postoperative perineal complications occurred as compared to
conventional surgery. ELAPE must be reserved for advanced low rectal cancers.
