Since its introduction,extralevator abdominoperineal excision(ELAPE)in the prone position has gained significant attention and recognition as an important surgical procedure for the treatment of advanced low rectal ca...Since its introduction,extralevator abdominoperineal excision(ELAPE)in the prone position has gained significant attention and recognition as an important surgical procedure for the treatment of advanced low rectal cancer.Most studies suggest that because of adequate resection and precise anatomy,ELAPE could decrease the rate of positive circumferential resection margins,intraoperative perforation,and may further decrease local recurrence rate and improve survival.Some studies show that extensive resection of pelvic floor tissue may increase the incidence of wound complications and urogenital dysfunction.Laparoscopic/robotic ELAPE and trans-perineal minimally invasive approach allow patients to be operated in the lithotomy position,which has advantages of excellent operative view,precise dissection and reduced postoperative complications.Pelvic floor reconstruction with biological mesh could significantly reduce wound complications and the duration of hospitalization.The proposal of individualized ELAPE could further reduce the occurrence of postoperative urogenital dysfunction and chronic perianal pain.The ELAPE procedure emphasizes precise anatomy and conforms to the principle of radical resection of tumors,which is a milestone operation for the treatment of advanced low rectal cancer.展开更多
AIM To introduce a novel,modified primary closure technique of laparoscopic extralevator abdominal perineal excision(LELAPE) for low rectal cancer.METHODS We retrospectively analyzed data from 76 patients with rectal ...AIM To introduce a novel,modified primary closure technique of laparoscopic extralevator abdominal perineal excision(LELAPE) for low rectal cancer.METHODS We retrospectively analyzed data from 76 patients with rectal cancer who underwent LELAPE from March 2013 to May 2016.Patients were classified into the modified primary closure group(32 patients) and the biological mesh closure group(44 patients).The total operating time,reconstruction time,postoperative stay duration,total cost,postoperative complications and tumor recur-rence were compared.RESULTS All surgery was successfully performed.The pelvic reconstruction time was 14.6 ± 3.7 min for the modified primary closure group,which was significantly longer than that of the biological mesh closure group(7.2 ± 1.9 min,P < 0.001).The total operating time was not different between the two groups(236 ± 20 min vs 248 ± 43 min,P = 0.143).The postoperative hospital stay duration was 8.1 ± 1.9 d,and the total cost was 9297 ± 1260 USD for the modified primary closure group.Notably,both of these categories were significantly lower in this group than those of the biological mesh closure group(P = 0.001 and P = 0.003,respectively).There were no differences observed between groups when comparing other perioperative data,long-term complications or oncological outcomes.CONCLUSION The modified primary closure method for reconstruction of the pelvic floor in LELAPE for low rectal cancer is technically feasible,safe and cost-effective.展开更多
Background:When compared with conventional abdominoperineal resection (APR),extralevator abdominoperineal excision (ELAPE) has been demonstrated to reduce the risk of local recurrence for the treatment of locally...Background:When compared with conventional abdominoperineal resection (APR),extralevator abdominoperineal excision (ELAPE) has been demonstrated to reduce the risk of local recurrence for the treatment of locally advanced low rectal cancer.Combined with the laparoscopic technique,laparoscopic ELAPE (LELAPE) has the potential to reduce invasion and hasten postoperative recovery.In this study,we aim to investigate the advantages of LELAPE in comparison with conventional APR.Methods:From October 2010 to February 2013,23 patients with low rectal cancer (T3-4N0-2M0) underwent LELAPE;while during the same period,25 patients were treated with conventional APR.The patient characteristics,intraoperative data,postoperative complications,and follow-up results were retrospectively compared and analyzed.Results:The basic patient characteristics were similar;but the total operative time for the LELAPE was longer than that of the conventional APR group (P =0.014).However,the operative time for the perineal portion was comparable between the two groups (P =0.328).The LELAPE group had less intraoperative blood loss (P =0.022),a lower bowel perforation rate (P =0.023),and a positive circumferential margin (P =0.028).Moreover,the patients,who received the LELAPE,had a lower postoperative Visual Analog Scale,quicker recovery of bowel function (P =0.001),and a shorter hospital stay (P =0.047).However,patients in the LELAPE group suffered more chronic perineal pain (P =0.002),which may be related to the coccygectomy (P =0.033).Although the metastasis rate and mortality rate were similar between the two groups,the local recurrence rate of the LELAPE group was statistically improved (P =0.047).Conclusions:When compared with conventional APR,LELAPE has the potential to reduce the risk of local recurrence,and decreases operative invasion for the treatment of locally advanced low rectal cancer.展开更多
Background:Extralevator abdominoperineal excision (ELAPE) has become a popular procedure for low rectal cancer as compared with abdominoperineal excision (APE). No definitive answer has been achieved whether one is su...Background:Extralevator abdominoperineal excision (ELAPE) has become a popular procedure for low rectal cancer as compared with abdominoperineal excision (APE). No definitive answer has been achieved whether one is superior to the other. This study aimed to evaluate the safety and efficacy of ELAPE for low rectal cancer with meta-analysis.Methods:The Web of Science, Cochrane Library, Embase, and PubMed databases before September 2019 were comprehensively searched to retrieve comparative trials of ELAPE and APE for low rectal cancer. Pooled analyses of the perioperative variables, surgical complications, and oncological variables were performed. Odds ratio (OR) and mean differences (MD) from each trial were pooled using random or fixed effects model depending on the heterogeneity of the included studies. A subgroup analysis or a sensitivity analysis was conducted to explore the potential source of heterogeneity when necessary.Results:This meta-analysis included 17 studies with 4049 patients, of whom 2248 (55.5%) underwent ELAPE and 1801 (44.5%) underwent APE. There were no statistical differences regarding the circumferential resection margin positivity (13.0% vs. 16.2%, OR = 0.69, 95% CI = 0.42-1.14, P = 0.15) and post-operative perineal wound complication rate (28.9% vs. 24.1%, OR = 1.21, 95% CI = 0.75-1.94, P= 0.43). The ELAPE was associated with lower rate of intraoperative perforation (6.6% vs. 11.3%, OR = 0.50, 95% CI = 0.39-0.64, P < 0.001) and local recurrence (8.8% vs. 20.5%, OR = 0.29, 95% CI = 0.21-0.41, P < 0.001) when compared with APE.Conclusions:The ELAPE was associated with a reduction in the rate of intra-operative perforation and local recurrence, without any increase in the circumferential resection margin positivity and post-operative perineal wound complication rate when compared with APE in the surgical treatment of low rectal cancer.展开更多
文摘Since its introduction,extralevator abdominoperineal excision(ELAPE)in the prone position has gained significant attention and recognition as an important surgical procedure for the treatment of advanced low rectal cancer.Most studies suggest that because of adequate resection and precise anatomy,ELAPE could decrease the rate of positive circumferential resection margins,intraoperative perforation,and may further decrease local recurrence rate and improve survival.Some studies show that extensive resection of pelvic floor tissue may increase the incidence of wound complications and urogenital dysfunction.Laparoscopic/robotic ELAPE and trans-perineal minimally invasive approach allow patients to be operated in the lithotomy position,which has advantages of excellent operative view,precise dissection and reduced postoperative complications.Pelvic floor reconstruction with biological mesh could significantly reduce wound complications and the duration of hospitalization.The proposal of individualized ELAPE could further reduce the occurrence of postoperative urogenital dysfunction and chronic perianal pain.The ELAPE procedure emphasizes precise anatomy and conforms to the principle of radical resection of tumors,which is a milestone operation for the treatment of advanced low rectal cancer.
基金Supported by the National Key and Development Program of China,No.2016YFC0106003the National Natural Science Foundation of China,No.81700708/H0712the Key and Development Program of Shandong Province,No.2016GSF201125
文摘AIM To introduce a novel,modified primary closure technique of laparoscopic extralevator abdominal perineal excision(LELAPE) for low rectal cancer.METHODS We retrospectively analyzed data from 76 patients with rectal cancer who underwent LELAPE from March 2013 to May 2016.Patients were classified into the modified primary closure group(32 patients) and the biological mesh closure group(44 patients).The total operating time,reconstruction time,postoperative stay duration,total cost,postoperative complications and tumor recur-rence were compared.RESULTS All surgery was successfully performed.The pelvic reconstruction time was 14.6 ± 3.7 min for the modified primary closure group,which was significantly longer than that of the biological mesh closure group(7.2 ± 1.9 min,P < 0.001).The total operating time was not different between the two groups(236 ± 20 min vs 248 ± 43 min,P = 0.143).The postoperative hospital stay duration was 8.1 ± 1.9 d,and the total cost was 9297 ± 1260 USD for the modified primary closure group.Notably,both of these categories were significantly lower in this group than those of the biological mesh closure group(P = 0.001 and P = 0.003,respectively).There were no differences observed between groups when comparing other perioperative data,long-term complications or oncological outcomes.CONCLUSION The modified primary closure method for reconstruction of the pelvic floor in LELAPE for low rectal cancer is technically feasible,safe and cost-effective.
文摘Background:When compared with conventional abdominoperineal resection (APR),extralevator abdominoperineal excision (ELAPE) has been demonstrated to reduce the risk of local recurrence for the treatment of locally advanced low rectal cancer.Combined with the laparoscopic technique,laparoscopic ELAPE (LELAPE) has the potential to reduce invasion and hasten postoperative recovery.In this study,we aim to investigate the advantages of LELAPE in comparison with conventional APR.Methods:From October 2010 to February 2013,23 patients with low rectal cancer (T3-4N0-2M0) underwent LELAPE;while during the same period,25 patients were treated with conventional APR.The patient characteristics,intraoperative data,postoperative complications,and follow-up results were retrospectively compared and analyzed.Results:The basic patient characteristics were similar;but the total operative time for the LELAPE was longer than that of the conventional APR group (P =0.014).However,the operative time for the perineal portion was comparable between the two groups (P =0.328).The LELAPE group had less intraoperative blood loss (P =0.022),a lower bowel perforation rate (P =0.023),and a positive circumferential margin (P =0.028).Moreover,the patients,who received the LELAPE,had a lower postoperative Visual Analog Scale,quicker recovery of bowel function (P =0.001),and a shorter hospital stay (P =0.047).However,patients in the LELAPE group suffered more chronic perineal pain (P =0.002),which may be related to the coccygectomy (P =0.033).Although the metastasis rate and mortality rate were similar between the two groups,the local recurrence rate of the LELAPE group was statistically improved (P =0.047).Conclusions:When compared with conventional APR,LELAPE has the potential to reduce the risk of local recurrence,and decreases operative invasion for the treatment of locally advanced low rectal cancer.
基金grants from the National Natural Science Foundation of China(No.81672439)the CapitaPs Funds for Health Improvement and Research(No.CFH 2018-2-2153)Beijing Municipal Administration of Hospitals Incubating Program(No.PX2016018).
文摘Background:Extralevator abdominoperineal excision (ELAPE) has become a popular procedure for low rectal cancer as compared with abdominoperineal excision (APE). No definitive answer has been achieved whether one is superior to the other. This study aimed to evaluate the safety and efficacy of ELAPE for low rectal cancer with meta-analysis.Methods:The Web of Science, Cochrane Library, Embase, and PubMed databases before September 2019 were comprehensively searched to retrieve comparative trials of ELAPE and APE for low rectal cancer. Pooled analyses of the perioperative variables, surgical complications, and oncological variables were performed. Odds ratio (OR) and mean differences (MD) from each trial were pooled using random or fixed effects model depending on the heterogeneity of the included studies. A subgroup analysis or a sensitivity analysis was conducted to explore the potential source of heterogeneity when necessary.Results:This meta-analysis included 17 studies with 4049 patients, of whom 2248 (55.5%) underwent ELAPE and 1801 (44.5%) underwent APE. There were no statistical differences regarding the circumferential resection margin positivity (13.0% vs. 16.2%, OR = 0.69, 95% CI = 0.42-1.14, P = 0.15) and post-operative perineal wound complication rate (28.9% vs. 24.1%, OR = 1.21, 95% CI = 0.75-1.94, P= 0.43). The ELAPE was associated with lower rate of intraoperative perforation (6.6% vs. 11.3%, OR = 0.50, 95% CI = 0.39-0.64, P < 0.001) and local recurrence (8.8% vs. 20.5%, OR = 0.29, 95% CI = 0.21-0.41, P < 0.001) when compared with APE.Conclusions:The ELAPE was associated with a reduction in the rate of intra-operative perforation and local recurrence, without any increase in the circumferential resection margin positivity and post-operative perineal wound complication rate when compared with APE in the surgical treatment of low rectal cancer.