Multicenter study of surgical and oncologic outcomes of extra-levator versus conventional abdominoperineal excision for lower rectal cancer |
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| Affiliation: | 1. Department of Gastroenterological Surgery, Peking University People''s Hospital, Beijing, 100044, PR China;2. Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People''s Hospital, Beijing, 100044, PR China;3. Center of Gastrointestinal Surgery, Beijing Cancer Hospital, Beijing, 100142, PR China;4. Department of General Surgery, Xuanwu Hospital Capital Medical University, Beijing, 100053, PR China;5. Department of General Surgery, Peking Union Medical College Hospital, Beijing, 100730, PR China;6. Department of Colorectal Surgery, National University Hospital of Singapore, Singapore;1. Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt;2. Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada;3. Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, Alberta, Canada;1. Department of Medicine, State University of New York at Buffalo, Buffalo, NY;2. Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY;3. Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY;4. Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, NY;5. Department of Medical Oncology, Mayo Clinic, Rochester, MN;1. Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia;2. Department of Surgical Oncology, Haematology and Oncology Clinic, Tartu University Hospital, Puusepa 8, 51014 Tartu, Estonia;3. Institute of Clinical Medicine, University of Tartu, Puusepa 8, 51014 Tartu, Estonia;1. Houston VA Center for Innovations In Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas;2. Department of Medicine, Baylor College of Medicine, Houston, Texas;3. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas;4. Department of Surgical Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas |
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| Abstract: | BackgroundThe surgical and oncological outcome of extra-levator abdominoperineal excision (ELAPE) procedure remains unclear in low rectal cancer.MethodsA total of 194 cases of rectal cancer patients underwent ELAPE or conventional abdominoperineal excision (APE) procedure were analyzed in four hospitals’ databases from January 2010 to December 2015. Clinicopathological data, overall survival (OS), disease free survival (DFS) and local recurrence free survival (LRFS) of patients were compared between two groups.ResultsThe operation time spent in perineal phase was significantly shorter in the ELAPE group than that in conventional APE procedure (P < 0.001). There were more specimens with excellent or good quality in ELAPE group compared to conventional APE group (P = 0.033). Patients whom underwent ELAPE procedures showed significantly better OS, DFS and LRFS than those underwent conventional APE procedures. Patients with preoperative stage cT3∼T4 (P = 0.033, P = 0.008, P = 0,033), cN+ (P = 0.002, P < 0.001, P = 0.006) and pathological stage III-IV (P = 0.023, P = 0.008, P = 0.016) were associated with significant benefits from ELAPE procedure in terms of OS, DFS and LRFS. DFS differed significantly between two groups of patients whom got preoperative chemoradiation therapy (P = 0.009) or postoperative chemotherapy (P = 0.029). For patients of pathological stage IIII-IV without preoperative chemoradiation, ELAPE procedures resulted in statistically better OS (P = 0.018) and DFS (P = 0.030). ELAPE procedure was an independent risk factor of OS, DFS and LRFS in multivariate analysis.ConclusionLow rectal cancer patients might benefit from ELAPE procedure on both surgical and oncological outcomes, especially in patients with relatively advanced tumors, inspite of the effects of pre-operative radio- and chemotherapy. |
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| Keywords: | Extra-levator abdominoperineal excision Rectal cancer Chemoradiotherapy Survival |
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