Wang Yan-Lei, Dai Yong, Jiang Jin-Bo, Yuan Hui-Yang, Hu San-Yuan
Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China.
Chin Med J (Engl). 2015 May 20;128(10):1340-5. doi: 10.4103/0366-6999.156779.
When compared with conventional abdominoperineal resection (APR), extralevator abdominoperineal excision (ELAPE) has been demonstrated to reduce the risk of local recurrence for the treatment of locally advanced low rectal cancer. Combined with the laparoscopic technique, laparoscopic ELAPE (LELAPE) has the potential to reduce invasion and hasten postoperative recovery. In this study, we aim to investigate the advantages of LELAPE in comparison with conventional APR.
From October 2010 to February 2013, 23 patients with low rectal cancer (T 3-4 N 0-2 M 0 ) underwent LELAPE; while during the same period, 25 patients were treated with conventional APR. The patient characteristics, intraoperative data, postoperative complications, and follow-up results were retrospectively compared and analyzed.
The basic patient characteristics were similar; but the total operative time for the LELAPE was longer than that of the conventional APR group (P = 0.014). However, the operative time for the perineal portion was comparable between the two groups (P = 0.328). The LELAPE group had less intraoperative blood loss (P = 0.022), a lower bowel perforation rate (P = 0.023), and a positive circumferential margin (P = 0.028). Moreover, the patients, who received the LELAPE, had a lower postoperative Visual Analog Scale, quicker recovery of bowel function (P = 0.001), and a shorter hospital stay (P = 0.047). However, patients in the LELAPE group suffered more chronic perineal pain (P = 0.002), which may be related to the coccygectomy (P = 0.033). Although the metastasis rate and mortality rate were similar between the two groups, the local recurrence rate of the LELAPE group was statistically improved (P = 0.047).
When compared with conventional APR, LELAPE has the potential to reduce the risk of local recurrence, and decreases operative invasion for the treatment of locally advanced low rectal cancer.
与传统腹会阴联合切除术（APR）相比，经肛提肌外腹会阴切除术（ELAPE）已被证明可降低局部晚期低位直肠癌治疗的局部复发风险。结合腹腔镜技术，腹腔镜ELAPE（LELAPE）有可能减少侵袭并加速术后恢复。在本研究中，我们旨在探讨LELAPE与传统APR相比的优势。
2010年10月至2013年2月，23例低位直肠癌（T3 - 4 N0 - 2 M0）患者接受了LELAPE；同期，25例患者接受了传统APR治疗。对患者特征、术中数据、术后并发症及随访结果进行回顾性比较和分析。
基本患者特征相似；但LELAPE的总手术时间比传统APR组长（P = 0.014）。然而，两组会阴部分的手术时间相当（P = 0.328）。LELAPE组术中出血量较少（P = 0.022），肠穿孔率较低（P = 0.023），环周切缘阳性率较低（P = 0.028）。此外，接受LELAPE的患者术后视觉模拟评分较低，肠功能恢复较快（P = 0.001），住院时间较短（P = 0.047）。然而，LELAPE组患者慢性会阴痛较多（P = 0.002），这可能与尾骨切除术有关（P = 0.033）。虽然两组的转移率和死亡率相似，但LELAPE组的局部复发率有统计学改善（P = 0.047）。
与传统APR相比，LELAPE有可能降低局部复发风险，并减少局部晚期低位直肠癌治疗的手术侵袭。
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