Holm Torbjörn
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Clin Colon Rectal Surg. 2017 Nov;30(5):357-367. doi: 10.1055/s-0037-1606113. Epub 2017 Nov 27.
Treatment results in rectal cancer have improved significantly during the recent two decades, but local control and survival after abdominoperineal excision (APE) have not improved to the same degree as that seen after anterior resection (AR). The reason for this is an increased risk of inadvertent bowel perforations and tumor involved margins after APE as compared with AR. The conventional synchronous combined APE has not been a standardized procedure and consequently oncological outcomes have varied considerably between different institutions and in different reports. With the new concept of APE, based on well-defined anatomical structures, the procedure can be categorized as intersphincteric APE, extralevator APE, and ischioanal APE. This article discusses the technical aspects and results from this approach.
在最近二十年中，直肠癌的治疗效果有了显著改善，但经腹会阴联合切除术（APE）后的局部控制和生存率并未像前切除术（AR）那样得到同等程度的提高。其原因是与AR相比，APE后意外肠穿孔和肿瘤切缘受累的风险增加。传统的同步联合APE并非标准化手术，因此不同机构和不同报告中的肿瘤学结果差异很大。基于明确的解剖结构，APE的新概念可将该手术分为括约肌间APE、肛提肌外APE和坐骨肛管APE。本文讨论了这种方法的技术要点和结果。
