Gürel Neşşar1, Ali Eba Demirbağ1, Bahadır Celep2, Orhan Hayri Elbir1, Cüneyt Kayaalp3

1Clinic of Gastrointestinal Surgery, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey
2Department of General Surgery, Kocatepe University School of Medicine, Afyon, Turkey
3Department of Gastrointestinal Surgery, İnönü University Turgut Özal Medical Center, Malatya, Turkey


Objective: Extralevator abdominoperineal excision (ELAPE) reduces the risk of positive circumferential resection margin (CRM) and of intraoperative perforation (IOP), both of which are associated with high local recurrence rates and poor survival outcomes for rectal cancer. The aim of this study was to compare the results of ELAPE with conventional abdominoperineal excision (APE) for low rectal cancer.
Material and Methods: A total of 25 consecutive patients underwent ELAPE for low rectal cancer between November 2008 and September 2011. Fifty-six patients treated by conventional APE prior to 2008 were selected from our rectal cancer database for comparison as a historical cohort.
Results: The mean follow-up was 44.7 months in the ELAPE group, and 70.6 months in the APE group. Patients undergoing ELAPE had a lower CRM positivity and IOP rate than APE (12% vs. 20%, p=0,531; 4% vs. 8,9%, p=0,826; respectively). The ELAPE group was associated with higher perineal wound complications than the APE group (16.0% vs. 1.8%, p=0.030). Local recurrence rates for patients in both groups did not differ significantly (4.0% vs. 3.6%, p=1.0).
Conclusion: The results of this study suggest that ELAPE technique was associated with less CRM involvement and reduced rates of IOP but markedly higher rates of postoperative perineal complications occurred as compared to conventional surgery. ELAPE must be reserved for advanced low rectal cancers.

Keywords: Extralevator abdominoperineal excision, margin involvement, perforation, rectal cancer


Ethics Committee Approval

Authors declared that the research was conducted according to the principles of the World Medical Association Declaration of Helsinki “Ethical Principles for Medical Research Involving Human Subjects”, (amended in October 2013).

Peer Review

Externally peer-reviewed.

Author Contributions

Concept – G.N.; Design – G.N., A.E.D.; Supervision – C.K.; Resources – G.N., A.E.D.; Materials – G.N., A.E.D., B.C., O.H.E.; Data Collection and/or Processing – G.N., A.E.D., B.C.; Analysis and/or Interpretation – G.N., A.E.D., C.K.; Literature Search – G.N., A.E.D.; Writing Manuscript – G.N., A.E.D.; Critical Review – G.N., A.E.D., B.C., O.H.E., C.K.; Other – G.N.

Conflict of Interest

No conflict of interest was declared by the authors.

Financial Disclosure

The authors declared that this study has received no financial support.