Experiences of Laparoscopic Extralevator Abdominoperineal Excision for 46 Cases of Advanced Low Rectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 XUTeng , XUWei , LIANGYong , FUWei , SONGHu , XUYi-xin ,  SongJun

Department of Gastrointestinal Surgery, Affiliated Hospital of Xuzhou Medicai College, Xuzhou, 221002, Jiangsu Province, China;

Corresponding author：

SongJun, Email: songjunwk@126.com

Keywords：

Low rectal cancer; Laparoscope; Extralevator abdominoperineal excision

DOI：

10.7507/1007-9424.20160056

Video：

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Objective To summarize experiences of laparoscopic extralevator abdominoperineal excision (ELAPE) in treatment of advanced low rectal cancer. Methods The clinical data of 46 patients with advanced low rectal cancer underwent laparoscopic ELAPE in our center from January 2012 to May 2015 were retrospectively analyzed.During the procedures,the anus and its surrounding tissue were individually resected by perineal approach with jackknife position.The pelvic perinium was closed laparoscopically.The operation time,intraoperative blood loss,retrieval of lymph nodes,radial margin,and postoperative complications were recorded. Results The procedures were successfully performed without any intraoperative complications,complications associated with laparoscopy,or conversion to the open approach.The operation time was (175.3±26.5) min.The intraoperative blood loss was (55.7±28.6) mL.The number of lymph node retrieval was 16.3±7.7.No positive radial margin was identified. Conclusion Sufficient resection of circumferential tissue,lower intraoperative perforation rate and satisfactory circumferential margin-negative rate could be achieved by laparoscopic ELAPE in treatment of advanced low rectal cancer.

Citation： XUTeng, XUWei, LIANGYong, FUWei, SONGHu, XUYi-xin, SongJun. Experiences of Laparoscopic Extralevator Abdominoperineal Excision for 46 Cases of Advanced Low Rectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(2): 218-220. doi: 10.7507/1007-9424.20160056 Copy

1.	West NP, Finan PJ, Anderin C, et al. Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer. J Clin Oncol, 2008, 26(21):3517-3522.
2.	Holm T, Ljung A, Häggmark 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.
3.	周晓武. 对腹腔镜直肠癌根治术的几点思考. 中华临床医师杂志:电子版, 2012, 6(21):6630-6632.
4.	Mauvais F, Sabbagh C, Brehant O, et al. The current abdominoperi-neal resection:Oncological problems and surgical modifications for low rectal cancer. J Visc Surg, 2011, 148(2):E85-E93.
5.	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.
6.	姚宏伟, 李文迪, 刘荫华. 肛提肌外腹会阴联合切除术治疗低位直肠癌必要性及适应证再探讨. 中国实用外科杂志, 2014, 34(9):804-807.
7.	郑民华. 不断提高腹腔镜直肠癌外科规范化治疗水平. 中华普外科手术学杂志:电子版, 2013, 7(2):81-84.
8.	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, 1972, 21(6):361-364.
9.	Herzog T, Belyaev O, Chromik AM, et al. TME quality in rectal cancer surgery. Eur J Med Res, 2010, 15:292-296.
10.	池畔, 陈致奋, 林惠铭, 等. 腹腔镜经腹柱状腹会阴联合切除术治疗低位直肠癌. 中华胃肠外科杂志, 2012, 15(6):589-593.
11.	Hermanek P, Merkel S, Fietkau R, et al. Regional lymph node metastasis and locoregional recurrence of rectal carcinoma in the era of TME[corrected] surgery. Implications for treatment decisions. Int J Colorectal Dis, 2010, 25(3):359-368.
12.	Anderin C, Martling A, Hellborg H, et al. A population-based study on outcome in relation to the type of resection in low rectal cancer. Dis Colon Rectum, 2010, 53(5):753-760.
13.	Wibe A, Rendedal PR, Svensson E, et al. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg, 2002, 89(3):327-334.
14.	Hermanek P, Junginger T. The circumferential resection margin in rectal carcinoma surgery. Tech Coloproctol, 2005, 9(3):193-200.
15.	Tekkis PP, Heriot AG, Smith J, et al. Comparison of circumferential margin involvement between restorative and nonrestorative resec-tions for rectal cancer. Colorectal Dis, 2005, 7(4):369-374.
16.	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.
17.	王振军, 韩加刚. 直肠癌柱状腹会阴联合切除术的技术和应用. 中华外科杂志, 2009, 47(3):229-231.
18.	王振军. 不能保肛的直肠癌手术治疗进展及评价. 中国实用外科杂志, 2012, 32(9):739-743.
19.	王振军. 经腹经骶柱状切除技术治疗复发直肠癌. 中国实用外科杂志, 2011, 31(4):358-360.
20.	Asplund D, Haglind E, Angenete E. Outcome of extralevator abdominoperineal excision compared with standard surgery:results from a single centre. Colorectal Dis, 2012, 14(10):1191-1196.
21.	Zhou X, Sun T, Xie H, et al. Extralevator abdominoperineal excision for low rectal cancer:a systematic review and meta-analysis of the short-term outcome. Colorectal Dis, 2015, 17(6):474-481.
22.	Marecik SJ, Zawadzki M, Desouza AL, et al. Robotic cylindrical abdominoperineal resection with transabdominal levator transec-tion. Dis Colon Rectum, 2011, 54(10):1320-1325.
23.	Bell SW, Dehni N, Chaouat M, et al. Primary rectus abdominis myocutaneous flap for repair of perineal and vaginal defects after extended abdominoperineal resection. Br J Surg, 2005, 92(4):482-486.
24.	Morino M, Parini U, Giraudo G, et al. Laparoscopic total mesorectal excision:a consecutive series of 100 patients. Ann Surg, 2003, 237(3): 335-342.
25.	Leroy J, Jamali F, Forbes L, et al. Laparoscopic total mesorectal excision (TME) for rectal cancer surgery:long-term outcomes. Surg Endosc, 2004, 18(2):281-289.
26.	Jayne DG, Thorpe HC, Copeland J, et al. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg, 2010, 97(11):1638-1645.

1. West NP, Finan PJ, Anderin C, et al. Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer. J Clin Oncol, 2008, 26(21):3517-3522.
2. Holm T, Ljung A, Häggmark 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.
3. 周晓武. 对腹腔镜直肠癌根治术的几点思考. 中华临床医师杂志:电子版, 2012, 6(21):6630-6632.
4. Mauvais F, Sabbagh C, Brehant O, et al. The current abdominoperi-neal resection:Oncological problems and surgical modifications for low rectal cancer. J Visc Surg, 2011, 148(2):E85-E93.
5. 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.
6. 姚宏伟, 李文迪, 刘荫华. 肛提肌外腹会阴联合切除术治疗低位直肠癌必要性及适应证再探讨. 中国实用外科杂志, 2014, 34(9):804-807.
7. 郑民华. 不断提高腹腔镜直肠癌外科规范化治疗水平. 中华普外科手术学杂志:电子版, 2013, 7(2):81-84.
8. 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, 1972, 21(6):361-364.
9. Herzog T, Belyaev O, Chromik AM, et al. TME quality in rectal cancer surgery. Eur J Med Res, 2010, 15:292-296.
10. 池畔, 陈致奋, 林惠铭, 等. 腹腔镜经腹柱状腹会阴联合切除术治疗低位直肠癌. 中华胃肠外科杂志, 2012, 15(6):589-593.
11. Hermanek P, Merkel S, Fietkau R, et al. Regional lymph node metastasis and locoregional recurrence of rectal carcinoma in the era of TME[corrected] surgery. Implications for treatment decisions. Int J Colorectal Dis, 2010, 25(3):359-368.
12. Anderin C, Martling A, Hellborg H, et al. A population-based study on outcome in relation to the type of resection in low rectal cancer. Dis Colon Rectum, 2010, 53(5):753-760.
13. Wibe A, Rendedal PR, Svensson E, et al. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg, 2002, 89(3):327-334.
14. Hermanek P, Junginger T. The circumferential resection margin in rectal carcinoma surgery. Tech Coloproctol, 2005, 9(3):193-200.
15. Tekkis PP, Heriot AG, Smith J, et al. Comparison of circumferential margin involvement between restorative and nonrestorative resec-tions for rectal cancer. Colorectal Dis, 2005, 7(4):369-374.
16. 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.
17. 王振军, 韩加刚. 直肠癌柱状腹会阴联合切除术的技术和应用. 中华外科杂志, 2009, 47(3):229-231.
18. 王振军. 不能保肛的直肠癌手术治疗进展及评价. 中国实用外科杂志, 2012, 32(9):739-743.
19. 王振军. 经腹经骶柱状切除技术治疗复发直肠癌. 中国实用外科杂志, 2011, 31(4):358-360.
20. Asplund D, Haglind E, Angenete E. Outcome of extralevator abdominoperineal excision compared with standard surgery:results from a single centre. Colorectal Dis, 2012, 14(10):1191-1196.
21. Zhou X, Sun T, Xie H, et al. Extralevator abdominoperineal excision for low rectal cancer:a systematic review and meta-analysis of the short-term outcome. Colorectal Dis, 2015, 17(6):474-481.
22. Marecik SJ, Zawadzki M, Desouza AL, et al. Robotic cylindrical abdominoperineal resection with transabdominal levator transec-tion. Dis Colon Rectum, 2011, 54(10):1320-1325.
23. Bell SW, Dehni N, Chaouat M, et al. Primary rectus abdominis myocutaneous flap for repair of perineal and vaginal defects after extended abdominoperineal resection. Br J Surg, 2005, 92(4):482-486.
24. Morino M, Parini U, Giraudo G, et al. Laparoscopic total mesorectal excision:a consecutive series of 100 patients. Ann Surg, 2003, 237(3): 335-342.
25. Leroy J, Jamali F, Forbes L, et al. Laparoscopic total mesorectal excision (TME) for rectal cancer surgery:long-term outcomes. Surg Endosc, 2004, 18(2):281-289.
26. Jayne DG, Thorpe HC, Copeland J, et al. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg, 2010, 97(11):1638-1645.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Experiences of Laparoscopic Extralevator Abdominoperineal Excision for 46 Cases of Advanced Low Rectal Cancer

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