Local recurrence after 'standard' abdominoperineal resection: do we really need ELAPE?
| Autor: | Nigel R. Hall, B. Jha, Nicola S Fearnhead, Richard J. Miller, David Greenberg, A. Xanthis, J. Davies, O. Olafimihan |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Colorectal cancer medicine.medical_treatment 030230 surgery Perineum Resection 03 medical and health sciences 0302 clinical medicine Abdomen medicine Retrospective analysis Humans Digestive System Surgical Procedures Short course radiotherapy Aged Retrospective Studies Curative intent Aged 80 and over business.industry Abdominoperineal resection Rectal Neoplasms General Medicine Middle Aged medicine.disease Surgery Radiation therapy 030220 oncology & carcinogenesis General Surgery Circumferential resection margin Female Neoplasm Recurrence Local business |
| Zdroj: | Annals of the Royal College of Surgeons of England. 100(2) |
| ISSN: | 1478-7083 |
| Popis: | Introduction Low rectal cancers requiring abdominoperineal resection tend to have a worse prognosis than higher tumours, which may be treated by anterior resection. One of the reasons for this may be inadequate local surgery, in particular the narrow waist of the resection specimen of a standard abdominoperineal resection may be associated with a high positive circumferential resection margin. The extralevator abdominoperineal excision (ELAPE) aims to improve the R0 resection rate but carries significant morbidity. We examined our own results of standard abdominoperineal resection to assess the need for a change of policy. Methods We operformed a retrospective analysis of consecutive standard abdominoperineal resections for rectal cancer in a single centre from June 2002 to December 2011. Results A total of 102 patients underwent standard abdominoperineal resection with curative intent; 19 had no preoperative treatment, 42 had short course radiotherapy, 9 had long course radiotherapy and 32 had neoadjuvant chemotherapy followed by long course chemoradiotherapy. In 17/102(16.6%), there was a positive circumferential resection margin. Over a median follow up of 32 months, 20 patients developed recurrence of any type. Local recurrence occurred in five patients (two of which also had distant recurrence), of whom two had a positive circumferential resection margin (P = 0.10). Actuarial two-year local only recurrence was 3.4% and any recurrence was 17.7%. Overall five-year cancer specific survival was 77%. Conclusions In this series we found low rates of local recurrence after standard abdominoperineal resection even with a circumferential margin rate positivity of 16.6%.Performing an ELAPE in selected cases may improve these results further but is not necessarily required for all patients. |
| Databáze: | OpenAIRE |
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