Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, 100044, PR China; Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, 100044, PR China.
Center of Gastrointestinal Surgery, Beijing Cancer Hospital, Beijing, 100142, PR China.
Eur J Surg Oncol. 2020 Jan;46(1):115-122. doi: 10.1016/j.ejso.2019.08.017. Epub 2019 Aug 21.
The surgical and oncological outcome of extra-levator abdominoperineal excision (ELAPE) procedure remains unclear in low rectal cancer.
A total of 194 cases of rectal cancer patients underwent ELAPE or conventional abdominoperineal excision (APE) procedure were analyzed in four hospitals' databases from January 2010 to December 2015. Clinicopathological data, overall survival (OS), disease free survival (DFS) and local recurrence free survival (LRFS) of patients were compared between two groups.
The operation time spent in perineal phase was significantly shorter in the ELAPE group than that in conventional APE procedure (P < 0.001). There were more specimens with excellent or good quality in ELAPE group compared to conventional APE group (P = 0.033). Patients whom underwent ELAPE procedures showed significantly better OS, DFS and LRFS than those underwent conventional APE procedures. Patients with preoperative stage cT3∼T4 (P = 0.033, P = 0.008, P = 0,033), cN+ (P = 0.002, P < 0.001, P = 0.006) and pathological stage III-IV (P = 0.023, P = 0.008, P = 0.016) were associated with significant benefits from ELAPE procedure in terms of OS, DFS and LRFS. DFS differed significantly between two groups of patients whom got preoperative chemoradiation therapy (P = 0.009) or postoperative chemotherapy (P = 0.029). For patients of pathological stage IIII-IV without preoperative chemoradiation, ELAPE procedures resulted in statistically better OS (P = 0.018) and DFS (P = 0.030). ELAPE procedure was an independent risk factor of OS, DFS and LRFS in multivariate analysis.
Low rectal cancer patients might benefit from ELAPE procedure on both surgical and oncological outcomes, especially in patients with relatively advanced tumors, inspite of the effects of pre-operative radio- and chemotherapy.
在低位直肠癌中，经肛提肌外腹会阴联合切除术（ELAPE）的手术和肿瘤学结果仍不清楚。
分析 2010 年 1 月至 2015 年 12 月 4 家医院数据库中接受 ELAPE 或传统腹会阴切除术（APE）的 194 例直肠癌患者的临床病理数据、总生存期（OS）、无病生存期（DFS）和局部无复发生存期（LRFS）。
ELAPE 组会阴期手术时间明显短于传统 APE 组（P < 0.001）。ELAPE 组标本质量优良者明显多于传统 APE 组（P = 0.033）。接受 ELAPE 手术的患者 OS、DFS 和 LRFS 明显优于接受传统 APE 手术的患者。术前 cT3∼T4（P = 0.033、P = 0.008、P = 0.033）、cN+（P = 0.002、P < 0.001、P = 0.006）和病理分期 III-IV（P = 0.023、P = 0.008、P = 0.016）的患者，ELAPE 手术在 OS、DFS 和 LRFS 方面获益明显。接受术前放化疗（P = 0.009）或术后化疗（P = 0.029）的两组患者 DFS 差异有统计学意义。对于无术前放化疗的病理分期 IIII-IV 期患者，ELAPE 手术在 OS（P = 0.018）和 DFS（P = 0.030）方面有统计学上的显著获益。ELAPE 手术是多因素分析中 OS、DFS 和 LRFS 的独立危险因素。
低位直肠癌患者从 ELAPE 手术的手术和肿瘤学结果中获益，尤其是对于肿瘤相对晚期的患者，尽管术前放化疗有影响。
