Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Int J Colorectal Dis. 2013 Apr;28(4):503-10. doi: 10.1007/s00384-012-1611-7. Epub 2012 Nov 21.
Extralevator abdominoperineal resection (APR) for low rectal cancer has been adopted by centers to improve oncological outcome. The present study aimed to investigate oncological results, wound complications, and quality of life (QoL).
Patients who underwent extralevator APR for rectal cancer between 2007 and 2011 were identified retrospectively. QoL status was assessed using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-CR30 and CR29 questionnaires.
Thirty laparoscopic (n = 7) or open (n = 23) extralevator APRs were performed in 17 male and 13 female patients. The mortality was zero; circumferential margin involvement occurred in two cases (6.7 %); and there was no bowel perforation. No local recurrence was noted after a median follow-up of 28.3 months; however, six patients died, and eight developed distant metastases. Perineal wound complications were found in 46.6 % of patients, and all were managed conservatively. Fifty percent of the patients reported persistent perineal pain at the follow-up exam. QoL was assessed 7 to 46 months after surgery, and the global health status (70.6) was comparable to the EORTC reference group and published conventional APR series. The QLQ-CR29 module revealed high mean symptom scores for urinary frequency (48.1), incontinence (30.5), and impotence (79.1).
Extralevator APR can control local recurrence but not distant metastases of low rectal cancer. The extended perineal resection appears not to decrease general QoL, but it results in a high rate of perineal wound complications. Genitourinary functions are often impaired, even in the long term, and further improvements to the technique must seek to reduce genitourinary harm.
为了提高肿瘤学治疗效果，一些中心采用了肛提肌外腹会阴联合切除术（APR）来治疗低位直肠癌。本研究旨在探讨其肿瘤学治疗效果、手术相关并发症及生活质量（QoL）。
回顾性分析了 2007 年至 2011 年间接受肛提肌外 APR 治疗的直肠癌患者。使用欧洲癌症研究与治疗组织（EORTC） QLQ-CR30 和 CR29 问卷评估 QoL 状况。
30 例腹腔镜（n=7）或开腹（n=23）APR 手术中，男性 17 例，女性 13 例。手术无死亡病例，2 例（6.7%）出现环周切缘阳性；无肠穿孔发生。中位随访 28.3 个月后，无局部复发；但有 6 例死亡，8 例出现远处转移。46.6%的患者出现会阴伤口并发症，均经保守治疗治愈。50%的患者在随访时仍有持续性会阴疼痛。术后 7 至 46 个月进行 QoL 评估，全球健康状况评分（70.6）与 EORTC 参考组和已发表的传统 APR 系列相当。QLQ-CR29 模块显示，尿频（48.1）、尿失禁（30.5）和勃起功能障碍（79.1）等症状的平均评分较高。
肛提肌外 APR 可控制低位直肠癌的局部复发，但不能控制远处转移。广泛的会阴切除似乎不会降低总体 QoL，但会导致较高的会阴伤口并发症发生率。泌尿生殖功能常常受损，即使在长期随访中也是如此，因此进一步改进手术技术必须致力于减少泌尿生殖系统的损害。
