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Multicenter Study
. 2020 Aug;24(8):823-831.
doi: 10.1007/s10151-020-02234-5. Epub 2020 Jun 16.

Transperineal minimally invasive APE: preliminary outcomes in a multicenter cohort

S E van Oostendorp  1 , S X Roodbeen  2 , C C Chen  3 , A Caycedo-Marulanda  4 , H M Joshi  5 , P J Tanis  2 , C Cunningham  5 , J B Tuynman  6 , R Hompes  2
Affiliations
Multicenter Study

Transperineal minimally invasive APE: preliminary outcomes in a multicenter cohort

S E van Oostendorp et al. Tech Coloproctol. 2020 Aug.

Abstract

Background: Abdominoperineal excision (APE) for rectal cancer is associated with a relatively high risk of positive margins and postoperative morbidity, particularly related to perineal wound healing problems. It is unknown whether the use of a minimally invasive approach for the perineal part of these procedures can improve postoperative outcomes without oncological compromise. The aim of this study was to evaluate the feasibility of minimally invasive transperineal abdominoperineal excision (TpAPE) METHODS: This multicenter retrospective cohort study included all patients having TpAPE for primary low rectal cancer. The primary endpoint was the intraoperative complication rate. Secondary endpoints included major morbidity (Clavien-Dindo ≥ 3), histopathology results, and perineal wound healing.

Results: A total of 32 TpAPE procedures were performed in five centers. A bilateral extralevator APE (ELAPE) was performed in 17 patients (53%), a unilateral ELAPE in 7 (22%), and an APE in 8 (25%). Intraoperative complications occurred in five cases (16%) and severe postoperative morbidity in three cases (9%). There were no perioperative deaths. A positive margin (R1) was observed in four patients (13%) and specimen perforation occurred in two (6%). The unilateral extralevator TpAPE group had worse specimen quality and a higher proportion of R1 resections than the bilateral ELAPE or standard APE groups. The rate of uncomplicated perineal wound healing was 53% (n = 17) and three patients (9%) required surgical reintervention.

Conclusions: TpAPE seems to be feasible with acceptable perioperative morbidity and a relatively low rate of perineal wound dehiscence, while histopathological outcomes remain suboptimal. Additional evaluation of the viability of this technique is needed in the form of a prospective trial with standardization of the procedure, indication, audit of outcomes and performed by surgeons with vast experience in transanal total mesorectal excision.

Keywords: Abdominoperineal excision; ELAPE; Rectal cancer; TME; TpAPE; Transperineal.

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Conflict of interest statement

The authors declare that they have no relevant conflict of interest.

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