Tao Yu, Han Jia-Gang, Wang Zhen-Jun
Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
World J Gastroenterol. 2020 Jun 14;26(22):3012-3023. doi: 10.3748/wjg.v26.i22.3012.
Since its introduction, extralevator abdominoperineal excision (ELAPE) in the prone position has gained significant attention and recognition as an important surgical procedure for the treatment of advanced low rectal cancer. Most studies suggest that because of adequate resection and precise anatomy, ELAPE could decrease the rate of positive circumferential resection margins, intraoperative perforation, and may further decrease local recurrence rate and improve survival. Some studies show that extensive resection of pelvic floor tissue may increase the incidence of wound complications and urogenital dysfunction. Laparoscopic/robotic ELAPE and trans-perineal minimally invasive approach allow patients to be operated in the lithotomy position, which has advantages of excellent operative view, precise dissection and reduced postoperative complications. Pelvic floor reconstruction with biological mesh could significantly reduce wound complications and the duration of hospitalization. The proposal of individualized ELAPE could further reduce the occurrence of postoperative urogenital dysfunction and chronic perianal pain. The ELAPE procedure emphasizes precise anatomy and conforms to the principle of radical resection of tumors, which is a milestone operation for the treatment of advanced low rectal cancer.
自引入以来，俯卧位经肛提肌腹会阴联合切除术（ELAPE）作为治疗晚期低位直肠癌的一项重要手术，已受到广泛关注并得到认可。大多数研究表明，由于切除充分且解剖精确，ELAPE可降低环周切缘阳性率、术中穿孔率，并可能进一步降低局部复发率，提高生存率。一些研究表明，盆底组织的广泛切除可能会增加伤口并发症和泌尿生殖功能障碍的发生率。腹腔镜/机器人ELAPE和经会阴微创入路可使患者在截石位进行手术，具有手术视野极佳、解剖精确和术后并发症减少的优点。使用生物补片进行盆底重建可显著减少伤口并发症和缩短住院时间。个体化ELAPE的提出可进一步减少术后泌尿生殖功能障碍和慢性肛周疼痛的发生。ELAPE手术强调精确解剖，符合肿瘤根治性切除原则，是治疗晚期低位直肠癌的一项里程碑式手术。
