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Erschienen in: International Journal of Colorectal Disease 10/2016

09.09.2016 | Original Article

Long-term outcome of extralevator abdominoperineal excision (ELAPE) for low rectal cancer

verfasst von: Sigmar Stelzner, Gunter Hellmich, Anja Sims, Thomas Kittner, Eric Puffer, Joerg Zimmer, Dorothea Bleyl, Helmut Witzigmann

Erschienen in: International Journal of Colorectal Disease | Ausgabe 10/2016

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Abstract

Purpose

Extralevator abdominoperineal excision (ELAPE) was introduced to improve outcomes for low-lying locally advanced rectal cancers (LARC) not amenable to sphincter preserving procedures. This study investigates prospectively outcomes of patients operated on with ELAPE compared with a similar cohort of patients operated on with conventional APE.

Methods

After the exclusion of patients without neoadjuvant therapy, in-hospital mortality, and incomplete metastatectomy, we identified 72 consecutive patients who had undergone either conventional APE (n = 36) or ELAPE (n = 36) for LARC ≤6 cm from the anal verge. The primary outcome measure was local recurrence at 5 years, and secondary outcome measures were cause-specific and overall survival.

Results

Median distance from the anal verge was significantly lower in the ELAPE group (2 vs. 4 cm, p = 0.029). Inadvertent bowel perforation could be completely avoided in the ELAPE group, but amounted to 16.7 % in the conventional APE group (p = 0.025). Cumulative local recurrence rate at 5 years was 18.2 % in the APE group compared to 5.9 % in the ELAPE group (p = 0.153). Local recurrence without distant metastases occurred in 15.5 % in the APE group but was not observed in the ELAPE group (p = 0.039). We did not detect significant differences in cause-specific nor in overall survival.

Conclusion

ELAPE results in lower local recurrence rates as compared with conventional APE. We conclude that the extralevator approach should be the procedure of choice for advanced low rectal cancer not amenable to sphincter preserving procedures.
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Metadaten
Titel
Long-term outcome of extralevator abdominoperineal excision (ELAPE) for low rectal cancer
verfasst von
Sigmar Stelzner
Gunter Hellmich
Anja Sims
Thomas Kittner
Eric Puffer
Joerg Zimmer
Dorothea Bleyl
Helmut Witzigmann
Publikationsdatum
09.09.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
International Journal of Colorectal Disease / Ausgabe 10/2016
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-016-2637-z

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