Department of Digestive Surgery and Urology, Turku University Hospital and University of Turku, Kiinanmyllynkatu 4-8, 20520, Turku, Finland.
Biostatistics, Department of Clinical Medicine, University of Turku, Turku, Finland.
Int J Colorectal Dis. 2018 Apr;33(4):375-381. doi: 10.1007/s00384-018-2977-y. Epub 2018 Feb 14.
To analyze the results of abdominoperineal excisions (APE) for locally advanced rectal cancer at our institution before and after the adoption of extralevator abdominoperineal excision (ELAPE) with a special reference to long-term survival.
A retrospective cohort study conducted in a tertiary referral center. All consecutive patients operated for locally advanced (TNM classification T3-4) rectal cancer with APE in 2004-2009 were compared to patients with similar tumors operated with ELAPE in 2009-2016.
Forty-two ELAPE and 27 APE patients were included. Circumferential resection margin (CRM) was less than 1 mm (R1-resection) in 10 (24%) of ELAPE patients and 11 (41%) of APE patients (p = 0.1358). Intraoperative perforation (IOP) occurred in 4 (10%) patients and 6 (22%) patients in ELAPE and APE groups, respectively (p = 0.1336). There were 3 (7%) local recurrences (LRs) in ELAPE group and 5 (19%) in APE (p = 0.2473). There were no statistical differences in adverse events, overall survival, or disease-free survival between ELAPE and APE groups.
We found a non-significant tendency to lower rates of IOP and positive CRM as well as lower rate of LR in the ELAPE group. Long-term survival and adverse events did not differ between the groups. ELAPE is beneficial for the surgeon in offering better vicinity to the perineal area and better work ergonomics. These technical aspects and the clinically very important tendency to lower rate of LR support the use of ELAPE technique in spite of the lack of survival benefit.
分析本机构采用经肛提肌外腹会阴联合切除术（ELAPE）前后对局部进展期直肠癌行腹会阴切除术（APE）的结果，特别关注长期生存情况。
这是在一家三级转诊中心进行的回顾性队列研究。比较了 2004 年至 2009 年间连续接受 APE 治疗的局部进展期（TNM 分类 T3-4 期）直肠癌患者与 2009 年至 2016 年间接受 ELAPE 治疗的类似肿瘤患者。
纳入了 42 例 ELAPE 和 27 例 APE 患者。ELAPE 组中有 10 例（24%）的环周切缘（CRM）小于 1mm（R1 切除），APE 组中有 11 例（41%）（p=0.1358）。ELAPE 组中有 4 例（10%）和 APE 组中有 6 例（22%）发生术中穿孔（IOP）（p=0.1336）。ELAPE 组中有 3 例（7%）发生局部复发（LR），APE 组中有 5 例（19%）（p=0.2473）。ELAPE 组和 APE 组之间的不良事件、总生存率或无病生存率无统计学差异。
我们发现 ELAPE 组的 IOP 和阳性 CRM 发生率以及 LR 发生率呈下降趋势，但差异无统计学意义。两组的长期生存和不良事件无差异。ELAPE 有利于外科医生更好地接近会阴区域，改善手术操作的人体工程学。这些技术方面以及临床上非常重要的 LR 发生率降低趋势支持采用 ELAPE 技术，尽管缺乏生存获益。
