nach oben

International Journal of Colorectal Disease

Erschienen in:

01.10.2011 | Review

Extended abdominoperineal excision vs. standard abdominoperineal excision in rectal cancer—a systematic overview

verfasst von: Sigmar Stelzner, Carsta Koehler, Juliane Stelzer, Anja Sims, Helmut Witzigmann

Erschienen in: International Journal of Colorectal Disease | Ausgabe 10/2011

Einloggen, um Zugang zu erhalten

Abstract

Background

After introduction of total mesorectal excision (TME) as the gold standard for rectal cancer surgery, oncologic results appeared to be inferior for abdominoperineal excision (APE) as compared to anterior resection. This has been attributed to the technique of standard APE creating a waist at the level of the tumor-bearing segment. This systematic review investigates outcome of both standard and extended techniques of APE regarding inadvertent bowel perforation, circumferential margin (CRM) involvement, and local recurrence.

Methods

A literature search was performed to identify all articles reporting on APE after the introduction of TME using Medline, Ovid, and Embase. Extended APE was defined as operations that resected the levator ani muscle close to its origin. All other techniques were taken to be standard. Studies so identified were evaluated using a validated instrument for assessing nonrandomized studies. Rates for perforation, CRM involvement, and local recurrence were compared using chi-square statistics.

Results

In the extended group, 1,097 patients, and in the standard group, 4,147 patients could be pooled for statistical analysis. The rate of inadvertent bowel perforation and the rate of CRM involvement for extended vs. standard APE was 4.1% vs. 10.4% (relative risk reduction 60.6%, p = 0.004) and 9.6% vs. 15.4% (relative risk reduction 37.7%, p = 0.022), respectively. The local recurrence rate was 6.6% vs. 11.9% (relative risk reduction 44.5%, p < 0.001) for the two groups.

Conclusion

This systematic review suggests that extended techniques of APE result in superior oncologic outcome as compared to standard techniques.

Nagtegaal ID, van de Velde CJ, Marijnen GC, van Krieken JHJM, Quirke P (2005) Low rectal cancer: a call for a change of approach in abdominoperineal resection. J Clin Oncol 23:9257–9264PubMed

Marr R, Birbeck K, Garvican J et al (2005) The modern abdominoperineal excision: the next challenge after total mesorectal excision. Ann Surg 242:74–82PubMed

den Dulk M, Putter H, Collette L et al (2009) The abdominoperineal resection itself is associated with an adverse outcome: the European experience based on a pooled analysis of five European randomized clinical trials on rectal cancer. Eur J Cancer 45:1175–1183

Holm T, Ljung A, Häggmark T, Jurell G, Lagergren J (2007) Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg 94:232–238PubMed

Quénu M (1896) Traitement du cancer du rectum; procède nouveau d’extirpation totale abdomino-périnéale. Bull Mém Soc Chir Paris 22:270–285

Kocher T (1907) Chirurgie des Mastdarms. In: Kocher T (ed) Chirurgische Operationslehre, 5th edn. Fischer, Jena, pp 965–984 (in German)

Miles WE (1908) A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon. Lancet 2:1812–1813

Miles WE (1910) The radical abdomino-perineal operation for cancer of the rectum and of the pelvic colon. Br Med J 2:941–943

Miles WE (1920) Surgical treatment of cancer of the rectum. Br Med J 2:730–734

10.

Kronberger L (1994) Historical development of sphincter preserving techniques in rectal carcinoma. Acta Chir Austriaca 26:124–126 (in German)

11.

Chessin DB, Guillem JG (2005) Abdominoperineal resection for rectal cancer: historic perspective and current issues. Surg Oncol Clin N Am 14:569–586PubMed

12.

Lange MM, Rutten HJ, van de Velde CJ (2009) One hundred years of curative surgery for rectal cancer: 1908–2008. Eur J Surg Oncol 35:453–463

13.

Black WA, Waugh JM (1948) The intramural extension of the rectum and rectosigmoid. Surg Gynecol Obstet 87:457–464PubMed

14.

Grinell RS (1954) Distal intramural spread of carcinoma of the rectum and rectosigmoid. Surg Gynecol Obstet 99:421–430

15.

Pollet WG, Nicholls RJ (1983) The relationship between the extent of distal clearance and survival and local recurrence rates after curative anterior resection for carcinoma of the rectum. Ann Surg 198:159–163

16.

Madsen PM, Christiansen J (1986) Distal intramural spread of rectal carcinomas. Dis Colon Rectum 29:279–282PubMed

17.

Kuvshinoff B, Maghfoor I, Miedema B et al (2001) Distal margin requirements after preoperative chemoradiotherapy for distal rectal carcinomas: are < or = 1 cm distal margins sufficient? Ann Surg Oncol 8:163–169PubMed

18.

Moore HG, Riedel E, Minsky BD et al (2003) Adequacy of 1-cm distal margin after restorative rectal cancer resection with sharp mesorectal excision and preoperative combined modality therapy. Ann Surg Oncol 10:80–85PubMed

19.

Lockhart-Mummery JP (1920) Resection of the rectum for cancer. Lancet 1:20–21

20.

Dixon CF (1948) Anterior resection for malignant lesions of the upper part of the rectum and lower part of the sigmoid. Ann Surg 128:425–442

21.

Gilchrist RK, Vernon DC (1938) Lymphatic spread of carcinoma of the rectum. Ann Surg 108:621–642PubMed

22.

Heald RJ, Moran BJ (1998) Embryology and anatomy of the rectum. Semin Surg Oncol 15:66–71PubMed

23.

Karanjia ND, Schache DJ, North WRS, Heald RJ (1990) ‘Close shave’ in anterior resection. Br J Surg 77:510–512PubMed

24.

Rullier E, Laurent C, Bretagnol F, Rullier A, Vendrely V, Zerbib F (2005) Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule. Ann Surg 241:465–469PubMed

25.

Tilney HS, Tekkis PP (2008) Extending the horizons of restorative rectal surgery: intersphincteric resection for low rectal cancer. Colorectal Dis 10:3–15PubMed

26.

Lloyd-Davies OV (1939) Lithotomy position for resection of rectum and pelvic colon. Lancet 2:74–76

27.

Goligher JC (1984) Abdominoperineal excision. In: Goligher JC (ed) Surgery of the anus, rectum and colon, 5th edn. BaillièreTindall, London, pp 619–656

28.

Heald RJ, Husband EM, Ryall RDH (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69:613–616PubMed

29.

Heald RJ, Moran BJ, Ryall RDH, Sexton R, MacFarlane JK (1998) The Basingstoke Experience of total mesorectal excision, 1978–1997. Arch Surg 133:894–899PubMed

30.

Havenga K, Enker WE, Norstein J et al (1999) Improved survival and local control after total mesorectal excision or D3 lymphadenectomy in the treatment of primary rectal cancer: an international analysis of 1411 patients. Eur J Sug Oncol 25:368–374

31.

Kapiteijn E, Putter H, van de Velde CJH (2002) Cooperative Investigators of the Dutch Colorectal Cancer Group. Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in the Netherlands. Br J Surg 89:1142–1149PubMed

32.

Wibe A, Møller B, Norstein J et al (2002) A national strategic change in treatment policy for rectal cancer—implementation of total mesorectal excision as routine treatment in Norway. A national audit. Dis Colon Rectum 45:857–866PubMed

33.

Martijn H, Voogd AC, van de Poll-Franse LV et al (2003) Improved survival of patients with rectal cancer since 1980: a population-based study. Eur J Cancer 39:2073–2079PubMed

34.

Visser O, Bakx R, Zoetmulder FA et al (2007) The influence of total mesorectal excision on local recurrence and survival in rectal cancer patients: a population-based study in Greater Amsterdam. J Surg Oncol 95:447–454PubMed

35.

den Dulk M, Krijnen P, Marijnen CA et al (2008) Improved overall survival for patients with rectal cancer since 1990: the effects of TME surgery and pre-operative radiotherapy. Eur J Cancer 44:1710–1716

36.

Heald RJ, Smedh RK, Kald A, Sexton R, Moran BJ (1997) Abdominoperineal excision of the rectum. An endangered operation. Dis Colon Rectum 40:747–751PubMed

37.

Wibe A, Syse A, Andersen E et al (2004) Oncological outcomes after total mesorectal excision for cure for the lower rectum: anterior vs abdomino-perineal resection. Dis Colon Rectum 47:48–58PubMed

38.

Law WL, Chu KW (2004) Abdominoperineal resection is associated with poor oncologic outcome. Br J Surg 91:1493–1499PubMed

39.

Eriksen MT, Wibe A, Syse A, Haffner J, Wiig JN (2004) Inadvertent perforation during rectal cancer resection in Norway. Br J Surg 91:210–216PubMed

40.

Aigner F, Zbar AP, Ludwikowki B, Kreczy A, Kovacs P, Fritsch H (2004) The rectogenital septum: morphology, function, and clinical relevance. Dis Colon Rectum 47:131–140PubMed

41.

West NP, Anderin C, Smith KJE, Holm T, Quirke P (2010) Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. Br J Surg 97:588–599PubMed

42.

Bebenek M (2009) Abdominosacral amputation of the rectum for low retal cancers: ten years of experience. Ann Surg Oncol 16:2211–2217PubMed

43.

Havenga K, Grossmann I, DeRuiter M, Wiggers T (2007) Definition of total mesorectal excision, including the perineal phase: technical considerations. Dig Dis 25:44–50PubMed

44.

van Dijk TH, Wiggers T, Havenga K (2010) Abdominoperineal resection for rectal cancer: reducing the risk of local recurrence. Sem Colon Rectum Surg 21:81–86

45.

Quirke P, Durdey P, Dixon MF, Williams NS (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 2:996–999PubMed

46.

Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 73:712–716PubMed

47.

Jayne DG, Guillou PJ, Thorpe H et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3 year results of the UK MRC CLASSIC Trial Group. J Clin Oncol 25:3061–3068PubMed

48.

Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASSIC trial): multicentre, randomized controlled trial. Lancet 365:1718–1726PubMed

49.

den Dulk M, Marijnen CA, Putter H et al (2007) Risk factors for adverse outcome in patients with rectal cancer treated with an abdominoperineal resection in the total mesorectal excision trial. Ann Surg 246:83–90

50.

Peeters KC, Marijnen CA, Nagtegaal ID et al (2007) The TME trial after a median follow-up of 6 years. Increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246:693–701PubMed

51.

Kusters M, Marijnen CA, van de Velde CJ (2010) Patterns of local recurrence in rectal cancer: a study of the Dutch TME trial. Eur J Surg Oncol 36:470–476PubMed

52.

Sebag-Montefiore D, Stephens RJ, Steele R et al (2009) Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 373:811–820PubMed

53.

Hermanek P, Merkel S, Fietkau R, Rödel C, Hohenberger W (2010) Regional lymph node metastasis and locoregional recurrence of rectal carcinoma in the era of TME surgery. Int J Colorectal Dis 25:359–368PubMed

54.

Tekkis P, Heriot A, Smith J, Thompson M, Finan P, Stamatakis J (2005) Comparison of circumferential margin involvement between restorative and nonrestorative resections for rectal cancer. Colorectal Dis 7:369–374PubMed

55.

Ptok H, Marusch F, Kuhn R, Gastinger I, Lippert H (2007) Influence of hospital volume on the frequency of abdominoperineal resection and long-term oncological outcomes in low rectal cancer. Eur J Surg Oncol 33:854–861PubMed

56.

Anderin C, Martling A, Hellborg BA, Holm T (2010) A population-based study on outcome in relation to the type of resection in low rectal cancer. Dis Colon Rectum 53:753–760PubMed

57.

Syk E, Glimelius B, Nilsson P (2010) Factors influencing local failure in rectal cancer: analysis of 2315 patients from a population-based series. Dis Colon Rectum 53:744–752PubMed

58.

Jögren F, Johansson R, Damber L, Lindmark G (2010) Risk factors of rectal cancer local recurrence: population-based survey and validation of the Swedish rectal cancer registry. Colorectal Dis 12:977–986

59.

Purves H, Pietrobon R, Hervey S, Guller U, Miller W, Ludwig K (2005) Relationship between surgeon caseload and sphincter preservation in patients with rectal cancer. Dis Colon Rectum 48:195–202PubMed

60.

Tilney HS, Heriot AG, Purkayastha S et al (2008) A national perspective on the decline of abdominoperineal resection for rectal cancer. Ann Surg 247:77–84PubMed

61.

Morris E, Quirke P, Thomas JD, Fairley L, Cottier B, Forman D (2008) Unacceptable variation in abdominoperineal excision rates for rectal cancer: time to intervene? Gut 57:1690–1697PubMed

62.

Martling A, Holm T, Rutqvist LE, Moran BJ, Heald RJ, Cedermark B (2000) Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Lancet 356:93–96PubMed

63.

Engel AF, Oomen JL, Eijsbouts QA, Cuesta MA, van de Velde CJ (2003) Nationwide decline in annual numbers of abdomino-perineal resections: effect of a successful national trial? Colorectal Dis 5:180–184PubMed

64.

Marusch F, Koch A, Schmidt U et al (2003) Importance of rectal extirpation for the therapy concept of low rectal cancers. Chirurg 74:341–352 (in German)PubMed

65.

Haward RA, Morris E, Monson JR, Johnston C, Forman D (2005) The long term survival of rectal cancer patients following abdominoperineal and anterior resection: results of a population based observational study. Eur J Surg Ongol 31:22–28

66.

Ricciardi R, Virnig BA, Madoff RD, Rothenberger DA, Baxter NN (2007) The status of radical proctectomy and sphincter-sparing surgery in the United States. Dis Colon Rectum 50:1119–1127PubMed

67.

Merkel S, Klossek D, Göhl J, Papadopoulos T, Hohenberger W, Hermanek P (2009) Quality management in rectal carcinoma: what is feasible? Int J Colorectal Dis 24:931–942PubMed

68.

Hodgson DC, Zhang W, Zaslavsky AM, Fuchs CS, Wright WE, Ayanian JZ (2003) Relation of hospital volume to colostomy rates and survival for patients with rectal cancer. J Natl Cancer Inst 95:708–716PubMed

69.

Nissan A, Guillem JG, Paty PB et al (2001) Abdominoperineal resection for rectal cancer at a specialty center. Dis Colon Rectum 44:27–36PubMed

70.

Hohenberger W, Bittorf B, Papadopoulos T, Merkel S (2005) Survival after surgical treatment of cancer of the rectum. Langebecks Arch Surg 390:363–372

71.

Goligher JC (1996) Ernest Miles. The rise and fall of abdominoperineal excision in the treatment of carcinoma of the rectum. J Pelvic Surg 2:53–54

72.

Påhlman L, Bohe M, Cedermark B et al (2007) The Swedish rectal cancer registry. Br J Surg 94:1285–1292PubMed

73.

Blomqvist L, Machado M, Rubio C et al (2000) Rectal tumour staging: MR imaging using pelvic phased-array and endorectal coils vs endoscopic ultrasonography. Eur Radiol 10:653–660PubMed

74.

Brown G, Daniels IR, Richardson C, Revell P, Peppercorn D, Bourne M (2005) Techniques and trouble-shooting in high spatial resolution thin slice MRI for rectal cancer. Br J Radiol 78:245–251PubMed

75.

Mercury Study Group (2006) Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal adenocarcinoma: prospective observation study. BMJ 333:749–782

76.

Shihab OC, Moran BJ, Heald RJ, Quirke P, Brown G (2008) MRI staging of low rectal cancer. Eur Radiol 19:643–650PubMed

77.

Weiser MR, Quah HM, Shia J et al (2009) Sphincter preservation in low rectal cancer is facilitated by preoperative chemoradiation and intersphincteric dissection. Ann Surg 249:236–242PubMed

78.

Radcliffe A (2006) Can the results of anorectal (abdominoperineal) resection be improved: are circumferential resection margins too often positive? Colorectal Dis 8:160–167PubMed

79.

Salerno GV, Chandler I, Wotherspoon A, Thomas K, Moran BJ, Brown G (2008) Sites of surgical waisting in the abdominoperineal specimen. Br J Surg 95:1147–1154PubMed

80.

Shihab OC, Brown G, Daniels IR, Heald RJ, Quirke P, Moran BJ (2010) Patients with low rectal cancer treated by abdominoperineal excision have worse tumors and higher involved margin rates compared with patients treated by anterior resection. Dis Colon Rectum 53:53–56PubMed

81.

Tilney HS, Tekkis PP, Sains PS, Constantinides VA, Heriot AG (2007) Factors affecting circumferential resection margin involvement after rectal cancer excision. Dis Colon Rectum 50:29–36PubMed

82.

Quirke P, Steele R, Monson J et al (2009) Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet 373:821–828PubMed

83.

Adam IJ, Mohamdee MO, Martin IG et al (1994) Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet 344:707–711PubMed

84.

De Haas-Kock DFM, Baeten CGMI, Jager JJ et al (1996) Prognostic significance of radial margins of clearance in rectal cancer. Br J Surg 83:781–785PubMed

85.

Wibe A, Rendedal PR, Svensson E et al (2002) Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg 89:375–379

86.

Birbeck KF, Macklin CP, Tiffin NJ et al (2002) Rates of circumferential resection margin involvement vary between surgeons and predict outcome in rectal cancer surgery. Ann Surg 235:449–457PubMed

87.

den Dulk M, Collette L, van de Velde CJ et al (2007) Quality of surgery in T3-4 rectal cancer: involvement of circumferential resection margin not influenced by preoperative treatment. Results from EORTC trial 22921. Eur J Cancer 43:1821–1828

88.

Nagtegaal ID, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26:303–312PubMed

89.

Quirke P, Dixon MF (1988) The prediction of local recurrence in rectal adenocarcinoma by histopathological examination. Int J Colorectal Dis 3:127–131PubMed

90.

Nagtegaal ID, Marijnen CA, Kranenbarg EK et al (2002) Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit. Am J Surg Path 26:350–357PubMed

91.

Bernstein TE, Endreseth PH, Romundstad P, Wibe A (2009) Circumferential resection margin as a prognostic factor in rectal cancer. Br J Surg 96:1348–1357PubMed

92.

Wittekind C, Compton C, Quirke P et al (2009) A uniform residual tumor (R) classification: integration of the R classification and the circumferential margin status. Cancer 115:3483–3488PubMed

93.

Porter GA, O’Keefe GE, Yakimets WW (1996) Inadvertent perforation of the rectum during abdominoperineal resection. Am J Surg 184:84–92

94.

Zirngibl H, Husemann B, Hermanek P (1990) Intraoperative spillage of tumor cells in surgery for rectal cancer. Dis Colon Rectum 33:610–614PubMed

95.

West NP, Finan PJ, Anderin C, Lindholm J, Holm T, Quirke P (2008) Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer. J Clin Oncol 26:3517–3522PubMed

96.

García-Granero E, Faiz O, Muñoz E et al (2009) Macroscopic assessment of mesorectal excision in rectal cancer: a useful tool for improving quality control in a multidisciplinary team. Cancer 115:3400–3411PubMed

97.

Nagtegaal ID, van de Velde CJ, van der Worp E et al (2002) Macroscopic evaluation of rectal cancer resection specimen. Clinical significance of the pathologist in quality control. J Clin Oncol 20:1729–1734PubMed

98.

Maslekar S, Sharma A, Macdonald A, Gunn J, Monson JR, Hartley JE (2007) Mesorectal grades predict recurrences after curative resection for rectal cancer. Dis Colon Rectum 50:168–175PubMed

99.

McDermott FT, Hughes ES, Phil E, Johnson WR, Price AB (1985) Local recurrence after potentially curative resection for rectal cancer in a series of 1008 patients. Br J Surg 72:34–37PubMed

100.

Danzi M, Ferulano GP, Abate S, Dilillo S, Califano G (1986) Survival and locations of recurrence following abdomino-perineal resection for rectal cancer. J Surg Oncol 31:235–239PubMed

101.

Neville R, Fielding LP, Amendola C (1987) Local tumor recurrence after curative resection for rectal cancer: a ten hospital review. Dis Colon Rectum 30:12–17PubMed

102.

Terranova O, Celi D, Martella B, Battocchio F (1989) Local recurrence of rectal cancer: anterior resection versus abomino-perineal resection. Int Surg 74:111–113PubMed

103.

Holm T, Cedermark B, Rutqvist LE (1994) Local recurrence of rectal adenocarcinoma after ‘curative’ surgery with and without preoperative radiotherapy. Br J Surg 81:452–455PubMed

104.

Tschmelitsch J, Kronberger P, Prommegger R, Reibenegger G, Glaser K, Bodner E (1995) Survival and local recurrence after anterior resection and abdominoperineal excision for rectal cancer. Eur J Surg Oncol 21:640–643PubMed

105.

Nymann T, Jess P, Christiansen J (1995) Rate and treatment of pelvic recurrence after abdominoperineal resection and low anterior resection for rectal cancer. Dis Colon Rectum 38:799–802PubMed

106.

Swedish Rectal Cancer Trial (1997) Improved survival with preoperative radiotherapy in resectable rectal cancer. New Engl J Med 336:980–987

107.

Rullier E, Laurent C, Carles J, Saric J, Michel P, Parneix M (1997) Local recurrence of low rectal cancer after abdominoperineal and anterior resection. Br J Surg 84:525–528PubMed

108.

Topal B, Penninckx F, Kaufman L et al (1998) Outcome after ‘curative’ surgery for carcinoma of the lower third of the rectum. Br J Surg 85:1118–1120PubMed

109.

Gamagami A, Liagre A, Chiotasso P, Istvan G, Lazorthes F (1999) Coloanal anastomosis for distal third rectal cancer. Prospective study of oncologic results. Dis Colon Rectum 42:1272–1275PubMed

110.

Stocchi L, Nelson H, Sargent DJ et al (2001) Impact of surgical and pathologic variables in rectal cancer: a United States community and cooperative group report. J Clin Oncol 19:3895–3902PubMed

111.

McCall LJ, Cox MR, Wattchow DA (1995) Analysis of local recurrence rates after surgery alone for rectal cancer. Int J Colorectal Dis 10:126–132PubMed

112.

Enker WE, Thaler HT, Cranor ML, Polyak T (1995) Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 181:335–346PubMed

113.

Chuwa EWL, Seow-Choen F (2005) Outcomes for abdominoperineal resections are not worse than those of anterior resection. Dis Colon Rectum 49:41–49

114.

Bokey EL, Öjerskog B, Chapuis PH, Dent OF, Newland RC, Sinclair G (1999) Local recurrence after curative excision of the rectum for cancer without adjuvant therapy: role of total anatomical dissection. Br J Surg 86:1164–1170PubMed

115.

Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740PubMed

116.

Silberfein EJ, Kattepogu KM, Hu CY et al (2010) Long term survival and recurrence outcomes following surgery for distal rectal cancer. Ann Surg Oncol 17:2863–2869PubMed

117.

Kim JS, Hur H, Kim NK et al (2009) Oncologic outcomes after radical surgery following preoperative chemoradiotherapy for locally advanced lower rectal cancer: abdominoperineal resection versus sphincter-preserving procedure. Ann Surg Oncol 16:1266–1273PubMed

118.

Marsh PJ, James RD, Schofield PF (1995) Definition of local recurrence after surgery for rectal carcinoma. Br J Surg 82:465–468PubMed

119.

Enker WE, Havenga K, Polyak T, Thaler H, Cranor M (1997) Abdominoperineal resection via total mesorectal excision and autonomic nerve preservation for low rectal cancer. World J Surg 21:715–720PubMed

120.

Dehni N, McFadden N, McNamara DA, Guiguet M, Tiret E, Parc R (2003) Oncologic results following abdominoperineal resection for adenocarcinoma of the low rectum. Dis Colon Rectum 46:867–874PubMed

121.

Okaro AC, Worthington T, Stebbing JF, Broughton M, Caffarey S, Marks CG (2006) Curative resection for low rectal adenocarcinoma: abdomino-perineal vs anterior resection. Colorectal Dis 8:645–649PubMed

122.

Smedh K, Khani MH, Kraaz W, Raab Y, Strand E (2006) Abdominoperineal excision with partial anterior en bloc resection on multimodal management of low rectal cancer: a strategy to reduce local recurrence. Dis Colon Rectum 49:833–840PubMed

123.

Davies M, Harries D, Hirst G et al (2009) Local recurrence after abdomino-perineal resection. Colorectal Dis 11:39–43PubMed

124.

Han JG, Wang ZJ, Gao ZG, Xu HM, Yang ZH, Jin ML (2010) Pelvic floor reconstruction using human acellular dermal matrix after cylindrical abdominoperineal resection. Dis Colon Rectum 53:219–223PubMed

125.

Stelzner S, Hellmich G, Schubert C, Puffer E, Haroske G, Witzigmann H (2011) Short term outcome of extra-levator abdominoperineal excision for rectal cancer. Int J Colorectal Dis. doi:10.1007/s00384-011-1157-0

126.

Kim NK, Baik SH, Seong JS et al (2006) Oncologic outcomes after neoadjuvant chemoradiation followed by curative resection with tumor-specific mesorectal excision for fixed locally advanced rectal cancer: impact of postirradiated pathologic downstaging on local recurrence and survival. Ann Surg 244:1024–1030PubMed

127.

Ferenschild FT, Dawson I, de Wilt JH, de Graaf EJ, Groenendijk RP, Tetteroo GW (2009) Total mesorectal excision for rectal cancer in an unselected population: quality assessment in a low volume center. Int J Colorectal Dis 24:923–929PubMed

128.

Dixon AR, Maxwell WA, Holmes JT (1991) Carcinoma of the rectum: a 10-year experience. Br J Surg 78:308–311PubMed

129.

Volpe C, Rodriguez-Bigas M, Petrelli NJ (1996) Wide perineal dissection and its effect on local recurrence following potentially curative abdominoperineal resection for rectal adenocarcinoma. Cancer Invest 14:1–5PubMed

130.

Ramos JR, Petrosemolo RH, Valory EA, Polania FC, Pecanha R (1997) Abdominoperineal resection: laparoscopic versus conventional. Surg Laparosc Endosc 7:148–152PubMed

131.

Zaheer S, Pemberton JH, Farouk R, Dozois RR, Wolff BG, Ilstrup D (1998) Surgical treatment of adenocarcinoma of the rectum. Ann Surg 227:800–811PubMed

132.

Arenas RB, Fichera A, Mhoon D, Michelassi F (1998) Total mesenteric excision in the surgical treatment of rectal cancer: a prospective study. Arch Surg 133:608–611PubMed

133.

Schwandner O, Schiedeck T, Killaitis C, Bruch HP (1999) A case-control-study comparing laparoscopic versus open surgery for rectosigmoidal and rectal cancer. Int J Colorectal Dis 44:158–163

134.

Baker RP, White EE, Titu L, Duthie GS, Lee PWR, Monsonj RT (2002) Does laparoscopic abdominoperineal resection of the rectum compromise long-term survival? Dis Colon Rectum 45:1481–1485PubMed

135.

Scheidbach H, Schneider C, Konradt J et al (2002) Laparoscopic abdominoperineal resection and anterior resection with curative intent for carcinoma of the rectum. Surg Endosc 16:7–13PubMed

136.

Moutardier V, Tardat E, Giovannini M et al (2003) Long-term results of preoperative radiotherapy for 113 cases of uT3 and uT4 rectal cancer: a need for long-term follow-up. Dis Colon Rectum 46:1194–1199PubMed

137.

Kneist W, Heintz A, Wolf HK, Junginger T (2003) Total excision of the mesorectum in cancer of the lower and middle rectum. Oncological and functional results. Chirurg 74:125–131 (in German)PubMed

138.

Lee SH, Hernandez de Anda E, Finne CO, Madoff RD, Garcia-Aguilar J (2005) The effect of circumferential tumor location in clinical outcomes of rectal cancer patients treated with total mesorectal excision. Dis Colon Rectum 48:2249–2257PubMed

139.

van der Vaart MG, van der Zwet WC, Arends JW, Eeftinck Schattenkerk M, Eddes EH (2006) Rectal carcinoma treated with short-term preoperative radiotherapy followed by abdominoperineal resection. Significantly more presacral abscesses with absence of local recurrence. Dig Surg 23:173–177PubMed

140.

Chiappa A, Biffi R, Bertani E et al (2006) Surgical outcomes after total mesorectal excision for rectal cancer. J Surg Oncol 94:182–193PubMed

141.

Jeyarajah S, Sutton CD, Miller AS, Hemingway D, Leicester Colorectal Specialist Group (2007) Factors that influence the adequacy of total mesorectal excision for rectal cancer. Colorectal Dis 9:808–815PubMed

142.

Orrom WJ, Hayashi AH, Kuechler D et al (2007) The surgical management of rectal cancer: a comparison of treatment methods and outcomes over 2 time periods in the same geographic region. Am J Surg 193:623–626PubMed

143.

Pugliese R, Di Lernia S, Sansonna F et al (2007) Outcomes of laparoscopic Miles’ operation in very low rectal adenocarcinoma. Analysis of 32 cases. Eur J Surg Oncol 33:49–54PubMed

144.

Strassburg J, Lewin A, Ludwig K et al (2007) Optimised surgery (so-called TME surgery) and high-resolution MRI in the planning of treatment of rectal carcinoma. Langenbecks Arch Surg 392:179–188PubMed

145.

Youssef H, Collantes EC, Rashid SH, Wong LS, Baragwanath P (2009) Rectal cancer: involved circumferential resection margin—a root cause analysis. Colorectal Dis 11:470–474PubMed

146.

Huh JW, Jung EJ, Park YA, Lee KY, Sohn SK (2008) Sphincter-preserving operations following preoperative chemoradiation: an alternative to abdominoperineal resection for lower rectal cancer? World J Surg 32:1116–1123PubMed

147.

Strassburg J, Junginger T, Trinh T et al (2009) Magnetic resonance imaging (MRI)-based indication for neaoadjuvant treatment of rectal carcinoma and the surrogate CRM status. Int J Colorectal Dis 23:1099–1107

148.

Chambers W, Khan A, Waters R et al (2010) Examination of outcome following abdominoperineal resection for adenocarcinoma in Oxford. Colorectal Dis 12:1192–1197PubMed

149.

Ng KH, Ng CD, Cheung HY (2009) Laparoscopic resection for rectal cancers: lessons learned from 579 cases. Ann Surg 249:82–86PubMed

Titel: Extended abdominoperineal excision vs. standard abdominoperineal excision in rectal cancer—a systematic overview
verfasst von: Sigmar Stelzner
Carsta Koehler
Juliane Stelzer
Anja Sims
Helmut Witzigmann
Publikationsdatum: 01.10.2011
Verlag: Springer-Verlag
Erschienen in: International Journal of Colorectal Disease / Ausgabe 10/2011
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-011-1235-3

Neu im Fachgebiet Chirurgie

Vorsicht, erhöhte Blutungsgefahr nach PCI!

10.05.2024 Koronare Herzerkrankung Nachrichten

Nach PCI besteht ein erhöhtes Blutungsrisiko, wenn die Behandelten eine verminderte linksventrikuläre Ejektionsfraktion aufweisen. Das Risiko ist umso höher, je stärker die Pumpfunktion eingeschränkt ist.

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Deutlich weniger Infektionen: Wundprotektoren schützen!

08.05.2024 Postoperative Wundinfektion Nachrichten

Der Einsatz von Wundprotektoren bei offenen Eingriffen am unteren Gastrointestinaltrakt schützt vor Infektionen im Op.-Gebiet – und dient darüber hinaus der besseren Sicht. Das bestätigt mit großer Robustheit eine randomisierte Studie im Fachblatt JAMA Surgery.

Chirurginnen und Chirurgen sind stark suizidgefährdet

07.05.2024 Suizid Nachrichten

Der belastende Arbeitsalltag wirkt sich negativ auf die psychische Gesundheit der Angehörigen ärztlicher Berufsgruppen aus. Chirurginnen und Chirurgen bilden da keine Ausnahme, im Gegenteil.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Springer Medizin

Abstract

Background

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 10/2011

Overall survival after resection for colon cancer in a national cohort study was adversely affected by TNM stage, lymph node ratio, gender, and old age

Multiple mutations in the Kras gene in colorectal cancer: review of the literature with two case reports

Cyclin D1 G870A polymorphism and colorectal cancer susceptibility: a meta-analysis of 20 populations

Protein biomarkers in exfoliated cells collected from the human rectal mucosa: implications for colorectal disease detection and monitoring

Intractable flatus incontinence treated by percutaneous tibial nerve stimulation

Long-term survival benefits of adjuvant chemotherapy by decreasing incidence of tumor recurrence without delaying relapse in stage III colorectal cancer

Update Chirurgie