Colorectal Surgery, North West Anglia NHS Foundation Trust, Peterborough, PE3 9GZ, UK.
Pennine Acute Hospitals NHS Trust, Manchester, UK.
Langenbecks Arch Surg. 2021 May;406(3):813-819. doi: 10.1007/s00423-021-02122-y. Epub 2021 Feb 27.
Abdominoperineal resection of the rectum has evolved over the last century, with few modifications until 2007, when extralevator abdominoperineal resection was introduced, which improved local disease control but resulted in a significant rise in perineal complications. We adopted a modified approach in which dissection was tailored according to magnetic resonance-defined tumour involvement. The aim of this study was to assess short-term and long-term oncological outcomes following a tailored abdominoperineal resection (APR) approach.
This study was a retrospective review of prospectively maintained databases at three centres: Portsmouth NHS Trust (UK), Poole General Hospital (UK) and Champalimaud's Cancer Foundation, Portugal. The study included consecutive patients who underwent abdominoperineal resection from October 2008 until April 2018 under the supervision of the senior author. Oncological outcomes, including overall survival and disease-free survival, were used as the main outcome measures.
A total of 584 patients underwent rectal cancer surgery during the study period. The APR ratio was 65/584 (11%). The median age was 66 years. Neoadjuvant treatment was administered to 74% of patients. Of the patients, 91% underwent surgery via a minimally invasive approach. The median hospital stay was 7 days. Patients were followed up for a median of 41 months. Only four patients had positive resection margins. The 5-year overall and disease-free survival rates were 64% and 62%, respectively.
Our data suggest that tailored APR has similar short-term and long-term oncological outcomes compared with extralevator abdominoperineal resection but reduced perineal wound complications. We believe this approach could be a safe alternative but recommend a larger sample size to accurately assess its effectiveness.
直肠腹会阴切除术在过去一个世纪中不断发展，直到 2007 年引入了经肛提肌外腹会阴切除术，这一术式提高了局部疾病控制率，但会阴并发症显著增加。我们采用了一种改良的方法，根据磁共振定义的肿瘤受累情况进行解剖。本研究旨在评估改良直肠腹会阴切除术（APR）的短期和长期肿瘤学结果。
这是对三个中心的前瞻性数据库进行的回顾性研究：朴茨茅斯国民保健制度信托基金会（英国）、普尔综合医院（英国）和葡萄牙夏蒙尼癌症基金会。该研究纳入了 2008 年 10 月至 2018 年 4 月期间在资深作者监督下接受直肠腹会阴切除术的连续患者。将肿瘤学结果，包括总生存率和无病生存率作为主要的观察指标。
在研究期间，共有 584 例患者接受了直肠癌手术。APR 比率为 65/584（11%）。中位年龄为 66 岁。74%的患者接受了新辅助治疗。91%的患者采用微创方法进行手术。中位住院时间为 7 天。中位随访时间为 41 个月。只有 4 例患者的切缘阳性。5 年总生存率和无病生存率分别为 64%和 62%。
我们的数据表明，与经肛提肌外腹会阴切除术相比，改良 APR 具有相似的短期和长期肿瘤学结果，但会阴伤口并发症减少。我们认为这种方法可能是一种安全的替代方法，但建议进行更大的样本量研究，以准确评估其效果。
