Multicenter study of surgical and oncologic outcomes of extra-levator versus conventional abdominoperineal excision for lower rectal cancer

被引：15

作者：

Shen, Zhanlong ^{[1
,2
]}

Bu, Zhaode ^{[3
]}

Li, Ang ^{[4
]}

Lu, Junyang ^{[5
]}

Zhu, Liyu ^{[1
,2
]}

Chong, Choon Seng ^{[6
]}

Gao, Zhidong ^{[1
,2
]}

Jiang, Kewei ^{[1
,2
]}

Wang, Shan ^{[1
,2
]}

Li, Fei ^{[4
]}

Xiao, Yi ^{[5
]}

Ji, Jiafu ^{[3
]}

Ye, Yingjiang ^{[1
,2
]}

机构：

[1] Peking Univ, Dept Gastroenterol Surg, Peoples Hosp, Beijing 100044, Peoples R China

[2] Peking Univ, Lab Surg Oncol, Beijing Key Lab Colorectal Canc Diag & Treatment, Peoples Hosp, Beijing 100044, Peoples R China

[3] Beijing Canc Hosp, Ctr Gastrointestinal Surg, Beijing 100142, Peoples R China

[4] Capital Med Univ, Xuanwu Hosp, Dept Gen Surg, Beijing 100053, Peoples R China

[5] Peking Union Med Coll Hosp, Dept Gen Surg, Beijing 100730, Peoples R China

[6] Natl Univ Singapore Hosp, Dept Colorectal Surg, Singapore, Singapore

来源：

EJSO | 2020年 / 46卷 / 01期

关键词：

Extra-levator abdominoperineal excision; Rectal cancer; Chemoradiotherapy; Survival; FLAP RECONSTRUCTION; PELVIC FLOOR; EXTRALEVATOR; RESECTION; SURGERY; STANDARD; EXPERIENCE; SURVIVAL; TERM;

D O I：

10.1016/j.ejso.2019.08.017

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background: The surgical and oncological outcome of extra-levator abdominoperineal excision (ELAPE) procedure remains unclear in low rectal cancer. Methods: 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. Results: 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 similar to 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. Conclusion: 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 preoperative radio- and chemotherapy. (C) 2019 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

引用

页码：115 / 122

页数：8

共 28 条

[1] Outcome of extralevator abdominoperineal excision compared with standard surgery: results from a single centre [J].

Asplund, D. ;

Haglind, E. ;

Angenete, E. .

COLORECTAL DISEASE, 2012, 14 (10) :1191-1196

[2] Prone cylindrical abdominoperineal resection with subsequent rectus abdominis myocutaneous flap reconstruction performed by a colorectal surgeon [J].

Barker, Jonathan A. ;

Blackmore, Alexander E. ;

Owen, Richard P. ;

Rate, Anthony .

INTERNATIONAL JOURNAL OF COLORECTAL DISEASE, 2013, 28 (06) :801-806

[3] Treatment of rectal cancer: Reduction of local recurrence after the introduction of TME - Experience from one university hospital [J].

Bernardshaw, Soosaipillai V. ;

Ovrebo, Kjell ;

Eide, Geir E. ;

Skarstein, Arne ;

Rokke, Ola .

DIGESTIVE SURGERY, 2006, 23 (1-2) :51-59

[4] Laparoscopic surgery for rectal cancer [J].

Chand, Manish ;

Bhoday, Jemma ;

Brown, Gina ;

Moran, Brendan ;

Parvaiz, Amjad .

JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, 2012, 105 (10) :429-435

[5] The abdominoperineal resection itself is associated with an adverse outcome: The European experience based on a pooled analysis of five European randomised clinical trials on rectal cancer [J].

den Dulk, Marcel ;

Putter, Hein ;

Collette, Laurence ;

Marijnen, Corrie A. M. ;

Folkesson, Joakim ;

Bosset, Jean-Francois ;

Roedel, Claus ;

Bujko, Krzysztof ;

Pahlman, Lars ;

van de Velde, Cornelis J. H. .

EUROPEAN JOURNAL OF CANCER, 2009, 45 (07) :1175-1183

[6] Pelvic Floor Reconstruction Using Human Acellular Dermal Matrix After Cylindrical Abdominoperineal Resection [J].

Han, Jia Gang ;

Wang, Zhen Jun ;

Gao, Zhi Gang ;

Xu, Hui Min ;

Yang, Zeng Hui ;

Jin, Mu Lan .

DISEASES OF THE COLON & RECTUM, 2010, 53 (02) :219-223

[7] THE MESORECTUM IN RECTAL-CANCER SURGERY - THE CLUE TO PELVIC RECURRENCE [J].

HEALD, RJ ;

HUSBAND, EM ;

RYALL, RDH .

BRITISH JOURNAL OF SURGERY, 1982, 69 (10) :613-616

[8] Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer [J].

Holm, T. ;

Ljung, A. ;

Haggmark, T. ;

Jurell, G. ;

Lagergren, J. .

BRITISH JOURNAL OF SURGERY, 2007, 94 (02) :232-238

[9] Controversies in Abdominoperineal Excision [J].

Holm, Torbjorn .

SURGICAL ONCOLOGY CLINICS OF NORTH AMERICA, 2014, 23 (01) :93-+

[10] Oncological superiority of extralevator abdominoperineal resection over conventional abdominoperineal resection: a meta-analysis [J].

Huang, Ao ;

Zhao, Hongchao ;

Ling, Tianlong ;

Quan, Yingjun ;

Zheng, Minhua ;

Feng, Bo .

INTERNATIONAL JOURNAL OF COLORECTAL DISEASE, 2014, 29 (03) :321-327

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