Han JG, Wang ZJ, Qian Q, Dai Y, Zhang ZQ, Yang JS, Li F, Li XB. A prospective multicenter clinical study of extralevator abdominoperineal resection for locally advanced low rectal cancer.
Dis Colon Rectum 2014;
57:1333-1340. [PMID:
25379997 DOI:
10.1097/dcr.0000000000000235]
[Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND
Recent studies have shown that extralevator abdominoperineal resection has the potential for reduced circumferential resection margin involvement, intraoperative bowl perforation, and local recurrence rates; however, it has been suggested that extended resection may be associated with increased morbidity because of the formation of a larger perineal defect.
OBJECTIVE
This study was undertaken to demonstrate the feasibility and complications of extralevator abdominoperineal resection for locally advanced low rectal cancer in China.
DESIGN
This was a prospective cohort study.
SETTING
The study was conducted at 7 university hospitals throughout China.
PATIENTS
A total of 102 patients underwent this procedure for primary locally advanced low rectal cancer between August 2008 and October 2011.
MAIN OUTCOME MEASURES
The main outcome measures comprised circumferential resection margin involvement, intraoperative perforation, postoperative complications, and local recurrence.
RESULTS
The most common complications included sexual dysfunction (40.5%), perineal complications (23.5%), urinary retention (18.6%), and chronic perineal pain (13.7%). Chronic perineal pain was associated with coccygectomy (p < 0.001), and the pain gradually eased over time. Reconstruction of the pelvic floor with biological mesh was associated with a lower rate of perineal dehiscence (p = 0.006) and overall perineal wound complications (p = 0.02) in comparison with primary closure. A positive circumferential margin was demonstrated in 6 (5.9%) patients, and intraoperative perforations occurred in 4 (3.9%) patients. All circumferential margin involvements and intraoperative perforations were located anteriorly. The local recurrence was 4.9% at a median follow-up of 44 months (range, 18-68 months).
LIMITATIONS
This was a nonrandomized, uncontrolled study.
CONCLUSIONS
Extralevator abdominoperineal resection performed in the prone position for low rectal cancer is a relatively safe approach with acceptable circumferential resection margin involvement, intraoperative perforations, and local recurrences. Reconstruction of the pelvic floor with biological mesh might lower the rate of perineal wound complications (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A161).
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