Pathology and Tumour Biology, Leeds Institute of Molecular Medicine, University of Leeds, UK.
Br J Surg. 2010 Apr;97(4):588-99. doi: 10.1002/bjs.6916.
Abdominoperineal excision (APE) for low rectal cancer is associated with higher rates of circumferential resection margin (CRM) involvement and intraoperative perforation (IOPs) than anterior resection for higher tumours. This multicentre observational study was designed to confirm that extralevator APE can improve outcomes and investigated the morbidity associated with such extensive surgery.
Some 176 extralevator APE procedures from 11 European colorectal surgeons were compared with 124 standard excisions from one UK centre. Clinical and pathological data were collected along with specimen photographs. Tissue morphometry was performed on the distal ten slices of the excision.
Extralevator APE removed more tissue from outside the smooth muscle layer per slice (median area 2120 versus 1259 mm(2); P < 0.001) leading to a reduction in CRM involvement (from 49.6 to 20.3 per cent; P < 0.001) and IOP (from 28.2 to 8.2 per cent; P < 0.001) compared with standard surgery. However, extralevator surgery was associated with an increase in perineal wound complications (from 20 to 38.0 per cent; P = 0.019).
Extralevator APE is associated with less CRM involvement and IOP than standard surgery.
与前切除术相比，腹会阴联合切除术（APE）治疗低位直肠癌时，环周切缘（CRM）受累和术中穿孔（IOP）的发生率更高。本多中心观察性研究旨在证实经括约肌外APE 可改善结局，并探讨广泛手术相关的发病率。
11 位欧洲结直肠外科医生进行的 176 例经括约肌外APE 手术与来自英国一家中心的 124 例标准切除手术进行了比较。收集了临床和病理数据以及标本照片。对切除标本的最后 10 个切片进行组织形态计量学分析。
与标准手术相比，经括约肌外APE 每片切除的平滑肌层外组织更多（中位数面积分别为 2120 毫米和 1259 毫米；P < 0.001），导致 CRM 受累（从 49.6%降至 20.3%；P < 0.001）和 IOP（从 28.2%降至 8.2%；P < 0.001）减少。然而，经括约肌外手术与会阴伤口并发症增加相关（从 20%升至 38.0%；P = 0.019）。
与标准手术相比，经括约肌外APE 与较少的 CRM 受累和 IOP 相关。
