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

Ramsay, G., Parnaby, C., MacKay, C., Hanlon, P. , Ong, S. and Loudon, M. (2013) Analysis of outcome using a levator sparing technique of abdominoperineal excision of rectum and anus. Cylindrical ELAPE is not necessary in all patients. European Journal of Surgical Oncology, 39(11), pp. 1219-1224. (doi:10.1016/j.ejso.2013.08.004) (PMID:23973512)

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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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Hanlon, Dr Peter
Authors: Ramsay, G., Parnaby, C., MacKay, C., Hanlon, P., Ong, S., and Loudon, M.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
Journal Name:European Journal of Surgical Oncology
Journal Abbr.:EJSO
Publisher:Elsevier
ISSN:0748-7983
ISSN (Online):1532-2157
Published Online:20 August 2013

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