Clinical Significance of Extra-Levator Abdominoperineal Excision_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 WANGZhan-yu ,  LIUYan

Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116027, Liaoning Province, China;

Corresponding?author：

LIUYan, Email: liuyan_2334@126.com

Keywords：

Extra-levator abdominoperineal excision; Rectal cancer; Perineal reconstruction; Circumferential resection margin

DOI：

10.7507/1007-9424.20150102

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the clinical advantages and the treatment of perineal defect of extra-levator abdominoperineal excision, and to discuss the treatments of postoperative complications. Methods Chinese or English literatures about extra-levator abdominoperineal excision were collected to summarize and analyze the clinical signifi-cance of it. Results Extra-levator abdominoperineal excision had a lot of advantages in reducing the circumferential resection margin involvement rate and intraoperative perforation rate for patients with low rectal cancer. The huge perineal defect caused by the operation could achieve good healing after appropriate treatment. At the same time, we should avoid the occurrence of urogenital system dysfunction and perineal pain. Conclusion Extra-levator abdomino-perineal excision is a safe and effective procedure aimed at patients with low rectal cancer, and can be applied during clinical practice.

Citation： WANGZhan-yu, LIUYan. Clinical Significance of Extra-Levator Abdominoperineal Excision. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(3): 380-383. doi: 10.7507/1007-9424.20150102 Copy

1.	?郁寶銘. 結直腸癌外科治療的現狀和展望. 中國普外基礎與臨床雜志, 2008, 15(9):631-636.
2.	郁寶銘. 低位直腸癌的診治進展. 中國實用外科雜志, 2002, 22(1):34-37.
3.	王振軍. 不能保肛的直腸癌手術治療進展及評價. 中國實用外科雜志, 2012, 32(9):739-743.
4.	Miles WE. A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon (1908). CA Cancer J Clin, 1971, 21(6):361-364.
5.	張舅. 直腸癌全直腸系膜切除術. 當代醫學, 2011, 17(23):2-3.
6.	Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence?. Br J Surg, 1982, 69(10):613-616.
7.	陳宏. 全直腸系膜切除術的臨床應用. 中國實用醫藥, 2011, 6 (11):51-53.
8.	Law WL, Chu KW. Abdominoperineal resection is associated with poor oncological outcome. Br J Surg, 2004, 91(11):1493-1499.
9.	Holm T, Ljung A, H?ggmark T, et al. Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg, 2007, 94(2):232-238.
10.	Dalton RS, Smart NJ, Edwards TJ, et al. Short-term outcomes of the prone perineal approach for extra-levator abdomino-perineal excision (elAPE). Surgeon, 2012, 10(6):342-346.
11.	Chambers W, Khan A, Waters R, et al. Examination of outcome following abdominoperineal resection for adenocarcinoma in Oxford. Colorectal Dis, 2010, 12(12):1192-1197.
12.	Stelzner S, Holm T, Moran BJ, et al. Deep pelvic anatomy revisited for a description of crucial steps in extralevator abdominoperineal excision for rectal cancer. Dis Colon Rectum, 2011, 54(8):947-957.
13.	Quirke P, Steele R, Monson J, et al. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer:a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet, 2009, 373(9666):821-828.
14.	Lin HH, Lin JK, Lin CC, et al. Circumferential margin plays an independent impact on the outcome of rectal cancer patients receiving curative total mesorectal excision. Am J Surg, 2013, 206(5):771-777.
15.	Eriksen MT, Wibe A, Syse A, et al. Inadvertent perforation during rectal cancer resection in Norway. Br J Surg, 2004, 91(2):210-216.
16.	Bebenek M, Pudelko M, Cisarz K, et al. Therapeutic results in low-rectal cancer patients treated with abdominosacral resection are similar to those obtained by means of anterior resection in mid-and upper-rectal cancer cases. Eur J Surg Oncol, 2007, 33(3):320-323.
17.	Stelzner S, Hellmich G, Schubert C, et al. Short-term outcome of extra-levator abdominoperineal excision for rectal cancer. Int J Colorectal Dis, 2011, 26(7):919-925.
18.	West NP, Anderin C, Smith KJ, et al. Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. Br J Surg, 2010, 97(4):588-599.
19.	Yu HC, Peng H, He XS, et al. Comparison of short-and long-term outcomes after extralevator abdominoperineal excision and standard abdominoperineal excision for rectal cancer:a systematic review and meta-analysis. Int J Colorectal Dis, 2014, 29(2):183-191.
20.	Martijnse IS, Dudink RL, West NP, et al. Focus on extralevator perineal dissection in supine position for low rectal cancer has led to better quality of surfery and oncologic outcome. Ann Surg oncol, 2012, 19(3):786-793.
21.	宋楓, 高峰, 趙勇, 等. 直腸癌經腹會陰柱狀切除術體會(附16例報告). 臨床外科雜志, 2012, 20(10):692-693.
22.	Nagtegaal ID, van de Velde CJ, Marijnen CA, et al. Low rectal cancer:a call for a change of approach in abdominoperineal resection. J Clin Oncol, 2005, 23(36):9257-9264.
23.	Vaughan-Shaw PG, King AT, Cheung T, et al. Early experience with laparoscopic extralevator abdominoperineal excision within an enhanced recovery setting:analysis of short-term outcomes and quality of life. Ann R Coll Surg Engl, 2011, 93(6):451-459.
24.	Welsch T, Mategakis V, Contin P, et al. Results of extralevator abdominoperineal resection for low rectal cancer including quality of life and long-term wound complications. Int J Colorectal Dis, 2013, 28(4):503-510.
25.	Nelson RA, Butler CE. Surgical outcomes of VRAM versus thigh flaps for immediate reconstruction of pelvic and perineal cancer resection defects. Plast Reconstr Surg, 2009, 123(1):175-183.
26.	Sunesen KG, Buntzen S, Tei T, et al. Perineal healing and survival after anal cancer salvage surgery:10-year experience with primary perineal reconstruction using the vertical rectus abdominis myocutaneous (VRAM) flap. Ann Surg Oncol, 2009, 16(1):68-77.
27.	Nisar PJ, Scott HJ. Myocutaneous flap reconstruction of the pelvis after abdominoperineal excision. Colorectal Dis, 2009, 11(8):806-816.
28.	Han JG, Wang ZJ, Gao ZG, et al. Pelvic floor reconstruction using human acellular dermal matrix after cylindrical abdominoperineal resection. Dis Colon Rectum, 2010, 53(2):219-223.
29.	Christensen HK, Nerstrom P, Tei TA. Perineal repair after extralevator abdominoperineal excision for low rectal cancer. Dis Colon Rectum, 2011, 54(6):711-717.
30.	Vaughan-Shaw PG, Cheung T, Knight JS, et al. A prospective case-control study of extralevator abdominoperineal excision (ELAPE) of the rectum versus conventional laparoscopic and open abdominoperineal excision:comparative analysis of short-term outcomes and quality of life. Tech Coloproctol, 2012, 16(5):355-362.
31.	Durai R, Harilingham M, Benziger H. Uterine flap:a simple method to reconstruct perineal defect following extralevator abdominoperineal resection in women. Ann R Coll Surg Engl, 2013, 95(6):442.
32.	A?ar H?, Kuzu MA. Perineal and pelvic anatomy of extralevator abdominoperineal excision for rectal cancer:cadaveric dissection. Dis Colon Rectum, 2011, 54(9):1179-1183.
33.	Han JG, Wang ZJ, Wei GH, et al. Randomized clinical trial of conventional versus cylindrical abdominoperineal resection for locally advanced lower rectal cancer. Am J Surg, 2012, 204(3):274-282.
34.	Wille-J?rgensen P, Pilsgaard B, M?ller P. Reconstruction of the pelvic floor with a biological mesh after abdominoperineal excision for rectal cancer. Int J Colorectal Dis, 2009, 24(3):323-325.
35.	Prytz M, Angenete E, Haglind E. Abdomonoperineal extralevator resection:a study of oncological outcome and well-being following abdominoperineal resection for rectal cancer-methodology. Dan Med J, 2012, 59(9):1-4.

1. ?郁寶銘. 結直腸癌外科治療的現狀和展望. 中國普外基礎與臨床雜志, 2008, 15(9):631-636.
2. 郁寶銘. 低位直腸癌的診治進展. 中國實用外科雜志, 2002, 22(1):34-37.
3. 王振軍. 不能保肛的直腸癌手術治療進展及評價. 中國實用外科雜志, 2012, 32(9):739-743.
4. Miles WE. A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon (1908). CA Cancer J Clin, 1971, 21(6):361-364.
5. 張舅. 直腸癌全直腸系膜切除術. 當代醫學, 2011, 17(23):2-3.
6. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence?. Br J Surg, 1982, 69(10):613-616.
7. 陳宏. 全直腸系膜切除術的臨床應用. 中國實用醫藥, 2011, 6 (11):51-53.
8. Law WL, Chu KW. Abdominoperineal resection is associated with poor oncological outcome. Br J Surg, 2004, 91(11):1493-1499.
9. Holm T, Ljung A, H?ggmark T, et al. Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg, 2007, 94(2):232-238.
10. Dalton RS, Smart NJ, Edwards TJ, et al. Short-term outcomes of the prone perineal approach for extra-levator abdomino-perineal excision (elAPE). Surgeon, 2012, 10(6):342-346.
11. Chambers W, Khan A, Waters R, et al. Examination of outcome following abdominoperineal resection for adenocarcinoma in Oxford. Colorectal Dis, 2010, 12(12):1192-1197.
12. Stelzner S, Holm T, Moran BJ, et al. Deep pelvic anatomy revisited for a description of crucial steps in extralevator abdominoperineal excision for rectal cancer. Dis Colon Rectum, 2011, 54(8):947-957.
13. Quirke P, Steele R, Monson J, et al. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer:a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet, 2009, 373(9666):821-828.
14. Lin HH, Lin JK, Lin CC, et al. Circumferential margin plays an independent impact on the outcome of rectal cancer patients receiving curative total mesorectal excision. Am J Surg, 2013, 206(5):771-777.
15. Eriksen MT, Wibe A, Syse A, et al. Inadvertent perforation during rectal cancer resection in Norway. Br J Surg, 2004, 91(2):210-216.
16. Bebenek M, Pudelko M, Cisarz K, et al. Therapeutic results in low-rectal cancer patients treated with abdominosacral resection are similar to those obtained by means of anterior resection in mid-and upper-rectal cancer cases. Eur J Surg Oncol, 2007, 33(3):320-323.
17. Stelzner S, Hellmich G, Schubert C, et al. Short-term outcome of extra-levator abdominoperineal excision for rectal cancer. Int J Colorectal Dis, 2011, 26(7):919-925.
18. West NP, Anderin C, Smith KJ, et al. Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. Br J Surg, 2010, 97(4):588-599.
19. Yu HC, Peng H, He XS, et al. Comparison of short-and long-term outcomes after extralevator abdominoperineal excision and standard abdominoperineal excision for rectal cancer:a systematic review and meta-analysis. Int J Colorectal Dis, 2014, 29(2):183-191.
20. Martijnse IS, Dudink RL, West NP, et al. Focus on extralevator perineal dissection in supine position for low rectal cancer has led to better quality of surfery and oncologic outcome. Ann Surg oncol, 2012, 19(3):786-793.
21. 宋楓, 高峰, 趙勇, 等. 直腸癌經腹會陰柱狀切除術體會(附16例報告). 臨床外科雜志, 2012, 20(10):692-693.
22. Nagtegaal ID, van de Velde CJ, Marijnen CA, et al. Low rectal cancer:a call for a change of approach in abdominoperineal resection. J Clin Oncol, 2005, 23(36):9257-9264.
23. Vaughan-Shaw PG, King AT, Cheung T, et al. Early experience with laparoscopic extralevator abdominoperineal excision within an enhanced recovery setting:analysis of short-term outcomes and quality of life. Ann R Coll Surg Engl, 2011, 93(6):451-459.
24. Welsch T, Mategakis V, Contin P, et al. Results of extralevator abdominoperineal resection for low rectal cancer including quality of life and long-term wound complications. Int J Colorectal Dis, 2013, 28(4):503-510.
25. Nelson RA, Butler CE. Surgical outcomes of VRAM versus thigh flaps for immediate reconstruction of pelvic and perineal cancer resection defects. Plast Reconstr Surg, 2009, 123(1):175-183.
26. Sunesen KG, Buntzen S, Tei T, et al. Perineal healing and survival after anal cancer salvage surgery:10-year experience with primary perineal reconstruction using the vertical rectus abdominis myocutaneous (VRAM) flap. Ann Surg Oncol, 2009, 16(1):68-77.
27. Nisar PJ, Scott HJ. Myocutaneous flap reconstruction of the pelvis after abdominoperineal excision. Colorectal Dis, 2009, 11(8):806-816.
28. Han JG, Wang ZJ, Gao ZG, et al. Pelvic floor reconstruction using human acellular dermal matrix after cylindrical abdominoperineal resection. Dis Colon Rectum, 2010, 53(2):219-223.
29. Christensen HK, Nerstrom P, Tei TA. Perineal repair after extralevator abdominoperineal excision for low rectal cancer. Dis Colon Rectum, 2011, 54(6):711-717.
30. Vaughan-Shaw PG, Cheung T, Knight JS, et al. A prospective case-control study of extralevator abdominoperineal excision (ELAPE) of the rectum versus conventional laparoscopic and open abdominoperineal excision:comparative analysis of short-term outcomes and quality of life. Tech Coloproctol, 2012, 16(5):355-362.
31. Durai R, Harilingham M, Benziger H. Uterine flap:a simple method to reconstruct perineal defect following extralevator abdominoperineal resection in women. Ann R Coll Surg Engl, 2013, 95(6):442.
32. A?ar H?, Kuzu MA. Perineal and pelvic anatomy of extralevator abdominoperineal excision for rectal cancer:cadaveric dissection. Dis Colon Rectum, 2011, 54(9):1179-1183.
33. Han JG, Wang ZJ, Wei GH, et al. Randomized clinical trial of conventional versus cylindrical abdominoperineal resection for locally advanced lower rectal cancer. Am J Surg, 2012, 204(3):274-282.
34. Wille-J?rgensen P, Pilsgaard B, M?ller P. Reconstruction of the pelvic floor with a biological mesh after abdominoperineal excision for rectal cancer. Int J Colorectal Dis, 2009, 24(3):323-325.
35. Prytz M, Angenete E, Haglind E. Abdomonoperineal extralevator resection:a study of oncological outcome and well-being following abdominoperineal resection for rectal cancer-methodology. Dan Med J, 2012, 59(9):1-4.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Significance of Extra-Levator Abdominoperineal Excision

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