Department of Surgery, Sahlgrenska University Hospital/Östra, University of Gothenburg, Gothenburg, Sweden.
Colorectal Dis. 2012 Oct;14(10):1191-6. doi: 10.1111/j.1463-1318.2012.02930.x.
Extralevator abdominoperineal excision (APE) for low rectal tumours has been introduced to achieve improved local radicality. Fewer positive margins and intraoperative perforations have been reported compared with standard APE. The aim of this retrospective study was to compare short-term complications and results of the two techniques in our institution.
Consecutive patients with rectal cancer undergoing APE between 2004 and 2009 were included. They were divided into two groups of 79 patients in extralevator APE and 79 in standard APE. Patients with recurrence and those having a palliative procedure were excluded. Data were collected from hospital records and the colorectal cancer registry. Main endpoints were wound infection, perineal wound revision, oncological data and length of hospital stay.
Circumferential resection margin positivity did not differ significantly between groups (17% extralevator APE; 20% standard APE). Intraoperative perforation (13%vs 10%) or local recurrence (seven in each group) were no different. Perineal wound infection was more common after extralevator APE (46%vs 28%, P<0.05) as was perineal wound revision (22%vs 8%, P<0.05). Hospital stay was longer after extralevator APE (median 12 vs 11days, P<0.05). Tumour height (median 4cm) and pTNM classification did not differ.
The results do not show any advantage for extralevator APE. The oncological data were no better and postoperative morbidity was increased. Further studies are needed before extralevator APE is widely adopted in clinical practice.
经肛门会阴联合切除术（APPE）用于低位直肠肿瘤，旨在提高局部根治性。与标准 APPE 相比，其报道的阳性切缘和术中穿孔较少。本回顾性研究旨在比较两种技术在我院的短期并发症和结果。
连续纳入 2004 年至 2009 年接受 APPE 的直肠癌患者。将其分为经肛门会阴联合切除术（extralevator APE）组 79 例和标准 APPE 组 79 例。排除复发病例和姑息性手术病例。数据来自医院记录和结直肠登记处。主要终点是伤口感染、会阴伤口修复、肿瘤学数据和住院时间。
两组的环周切缘阳性率无显著差异（extralevator APE 组 17%；标准 APPE 组 20%）。术中穿孔（13%对 10%）或局部复发（两组各 7 例）无差异。经肛门会阴联合切除术（extralevator APE）后会阴伤口感染更常见（46%对 28%，P<0.05），会阴伤口修复更常见（22%对 8%，P<0.05）。经肛门会阴联合切除术（extralevator APE）的住院时间更长（中位数 12 天对 11 天，P<0.05）。肿瘤高度（中位数 4cm）和 pTNM 分类无差异。
结果显示经肛门会阴联合切除术（extralevator APE）没有优势。肿瘤学数据没有改善，术后发病率增加。在经肛门会阴联合切除术（extralevator APE）广泛应用于临床实践之前，还需要进一步研究。
