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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 2/2014

01-02-2014 | Original Article

Comparison of short- and long-term outcomes after extralevator abdominoperineal excision and standard abdominoperineal excision for rectal cancer: a systematic review and meta-analysis

Authors: Hui-Chuan Yu, Hui Peng, Xiao-Sheng He, Ri-Sheng Zhao

Published in: International Journal of Colorectal Disease | Issue 2/2014

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Abstract

Purpose

Whether the introduction of extralevator abdominoperineal excision (ELAPE) improves survival and safety remains controversial. We conducted a systematic review and meta-analysis of all comparative studies to define the efficacy and safety of ELAPE and standard abdominoperineal excision (APE).

Materials and methods

A search for all major databases and relevant journals from inception to July 2013 without restriction on languages or regions was performed. Outcome measures were the oncological parameters of circumferential resection margin (CRM) involvement, intraoperative bowel perforation (IOP), and local recurrence, as well as other parameters of blood loss, operative time, length of hospitalization, and postoperative complication. The test of heterogeneity was performed with the Q statistic.

Results

A total of 949 patients were included in the meta-analysis. Oncological pooled estimates of intraoperative bowel perforation rate (RR 0.34; 95 % CI 0.21–0.54; P < 0.00001), CRM involvement (RR 0.44; 95 % CI 0.34–0.56; P < 0.00001), and local recurrence (RR 0.32; 95 % CI 0.14–0.74; P = 0.008) all showed outcomes that were significantly lower in ELAPE than in APE. A similar incidence of postoperative complication was attributed to both groups, including overall complication (RR 0.93; 95 % CI 0.66–1.32; P = 0.69), perineal wound complication (RR 0.72; 95 % CI 0.33–1.55; P = 0.39), and urinary dysfunction (RR 1.53; 95 % CI 0.88–2.67; P = 0.13).

Conclusion

ELAPE has a lower intraoperative bowel perforation rate, positive CRM rate, and local recurrence rate than APE. There is evidence that in selected low rectal cancer patients, ELAPE is a more efficient and equally safe option to replace APE. Due to the inherent limitations of the present study, future randomized controlled trials will be useful to confirm this conclusion.
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Metadata
Title
Comparison of short- and long-term outcomes after extralevator abdominoperineal excision and standard abdominoperineal excision for rectal cancer: a systematic review and meta-analysis
Authors
Hui-Chuan Yu
Hui Peng
Xiao-Sheng He
Ri-Sheng Zhao
Publication date
01-02-2014
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 2/2014
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-013-1793-7

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