ReviewExtralevator vs conventional abdominoperineal resection for rectal cancer—A systematic review and meta-analysis
Section snippets
Methods
This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.17 Electronic search, study selection, data extraction, and quality assessment were performed independently by 3 reviewers.
Results of the search
The initial electronic and printed literature research found 439 articles; 37 articles were assessed for eligibility as full text, of which 24 did not address the intervention of interest. Four studies were further excluded,24, 25, 26, 27 and their patients being included in other larger multicenter studies.5, 15, 16, 28 A total of 1 RCT (from China)29 and 10 NRCSs (8 from Europe and 2 from Asia)5, 14, 15, 16, 28, 30, 31, 32, 33, 34, 35 met the inclusion criteria for the qualitative and
Comments
The present study showed that ELAPE was associated with a significantly lower intraoperative perforation rate, with no benefits regarding CRM involvement and local recurrence rate. For the first time, the findings reveal a statistically significant, improved 3-year overall and disease-free survival for ELAPE patients. Contrary to the previous data, the postoperative morbidity of ELAPE seems to be similar to that of CAPR. Regarding CRM positivity, our results are similar with the results of Zhou
Conclusions
The present study showed that ELAPE significantly lowered the intraoperative perforation rate, with no benefits regarding CRM involvement and local recurrence rate. ELAPE was also associated with a statistically significant improved 3-year overall and disease-free survival. Nevertheless, one size does not fit all in low rectal cancer surgery, and further studies should define the subgroup of patients who would benefit the most from ELAPE.
Acknowledgment
The authors would like to thank Regina Kirby for language editing and proofreading of the manuscript.
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Cited by (32)
Long-term follow-up of bilateral gracilis reconstruction following extra-levator abdominoperineal excision
2023, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :The abdominoperineal excision (APE) operation, first described by W. Ernest Miles,1 has evolved over the last 115 years with recognition of the importance of the relationship between the tumour and the surgical circumferential resection margin, as well as a focus on reducing tumour perforation rates, together leading to improved cancer outcomes.2 Miles’ original description focused on a wide perineal excision, and this is the principle of the ‘modern MRI-guided extra-levator abdominoperineal excision’ (elAPE) procedure.2,3 The wider defect created increases the potential curative resection rates for both low rectal and anal cancer and is often in combination with pre-operative chemoradiotherapy.3,4
Partial myocutaneous gluteal flap for perineal reconstruction of extralevator abdominoperineal defects. A single surgeon series of 49 cases in 8 years, and a modification of the technique
2022, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :Extralevator abdominoperineal excision (ELAPE) for rectal cancer results in a significantly larger perineal soft tissue defect than abdominoperineal excision of the rectum (APER). The oncological benefits of ELAPE remain somewhat controversial,1-3 nevertheless an increase in the number of patients undergoing this procedure for rectal carcinoma necessitates that the reconstructive surgeon has a robust and reliable method of reconstructing the perineum. Various reconstructive methods have been discussed in the literature.
Laparoscopic extralevator abdominoperineal resection versus laparoscopic abdominoperineal resection for lower rectal cancer: A retrospective comparative study from China
2019, International Journal of SurgeryCitation Excerpt :This result was in line with our expectation and is consistent with three original studies [1,2,14]. Ionut Negoi et al. [22] recently performed a meta-analysis of 11 comparative studies and demonstrated that ELAPR significantly reduced the IOP rate, with no benefits regarding the rates of CRM positivity or LR. The identification of anatomical landmarks was important in LELAPR, especially perineal operations.
Prone Compared With Lithotomy for Abdominoperineal Resection: A Systematic Review and Meta-analysis
2019, Journal of Surgical ResearchCitation Excerpt :The use of this ELAPR technique may reduce perforation rates and CRM positivity independent of patient positioning.18 However, a recent review failed to demonstrate an improvement in oncologic outcomes with the use of ELAPR compared with traditional APR.40 Nonetheless, the ELAPR technique is a significant confounding variable in the present review. Three of the included studies compared ELAPR and prone positioning with traditional APR and lithotomy positioning.
Case series of in situ pelvic floor reconstruction combining levator ani suture and negative pressure wound therapy for abdominoperineal resection
2019, Annals of Medicine and SurgeryCitation Excerpt :Since 1931, when Miles proposed APR for low rectal cancer, this procedure had been the standard treatment, leading to significant improvement in local recurrence rates [9]. However, extralevator APR (ELAPR) with complete resection of the pelvic floor muscles is superior to conventional APR (CAPR), decreasing local recurrence for advanced low rectal cancer without a substantial surgical margin [10–12]. ELAPR requires reconstruction using a skin flap and is invasive and carries a high risk for wound infection.
There were no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs.
The authors declare no conflicts of interest.