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. 2022 Jun 22;22(1):242.
doi: 10.1186/s12893-022-01692-y.

Long-term outcomes after extra-levator versus conventional abdominoperineal excision for low rectal cancer

Haoyu Zhang  1 , Ganbin Li  1 , Ke Cao  1 , Zhiwei Zhai  1 , Guanghui Wei  1 , Chunxiang Ye  1 , Baocheng Zhao  1 , Zhenjun Wang  2 , Jiagang Han  3
Affiliations

Long-term outcomes after extra-levator versus conventional abdominoperineal excision for low rectal cancer

Haoyu Zhang et al. BMC Surg. .

Abstract

Purpose: Extralevator (ELAPE) and abdominoperineal excision (APE) are two major surgical approaches for low rectal cancer patients. Although excellent short-term efficacy is achieved in patients undergoing ELAPE, the long-term benefits have not been established. In this study we evaluated the safety, pathological and survival outcomes in rectal cancer patients who underwent ELAPE and APE.

Methods: One hundred fourteen patients were enrolled, including 68 in the ELAPE group and 46 in the APE group at the Beijing Chaoyang Hospital, Capital Medical University from January 2011 to November 2020. The baseline characteristics, overall survival (OS), progression-free survival (PFS), and local recurrence-free survival (LRFS) were calculated and compared between the two groups.

Results: Demographics and tumor stage were comparable between the two groups. The 5-year PFS (67.2% versus 38.6%, log-rank P = 0.008) were significantly improved in the ELAPE group compared to the APE group, and the survival advantage was especially reflected in patients with pT3 tumors, positive lymph nodes or even those who have not received neoadjuvant chemoradiotherapy. Multivariate analysis showed that APE was an independent risk factor for OS (hazard ratio 3.000, 95% confidence interval 1.171 to 4.970, P = 0.004) and PFS (hazard ratio 2.730, 95% confidence interval 1.506 to 4.984, P = 0.001).

Conclusion: Compared with APE, ELAPE improved long-term outcomes for low rectal cancer patients, especially among patients with pT3 tumors, positive lymph nodes or those without neoadjuvant chemoradiotherapy.

Keywords: Abdominoperineal excision; Extralevator abdominoperineal excision; Rectal cancer; Suvival.

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Conflict of interest statement

The authors of the article do not have commercial associations (e.g., consultancies, stock ownership, equity interests, patent-licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Figures

Fig. 1
Fig. 1
Study flow chart. ELAPE: extralevator abdominoperineal excision; APE: abdominoperineal excision
Fig. 2
Fig. 2
Comparison of overall survival, progression-free survival and local-recurrence-free survival between patients who underwent ELAPE and APE procedures. a overall survival; b progression-free survival; c local recurrence-free survival. ELAPE: extralevator abdominoperineal excision; APE: abdominoperineal excision
Fig. 3
Fig. 3
Comparison of overall survival, progression-free survival and local recurrence-free survival between patients of pT3, pT1 − 2 and pT4 tumors or those with positive lymph nodes who underwent ELAPE and APE procedure. a pT3: overall survival; b pT3: progression-free survival; c pT3: local recurrence-free survival; d pT1 − 2: overall survival; e pT1 − 2: progression-free survival; f pT1 − 2: local recurrence-free survival; g pT4: overall survival; h pT4: progression-free survival; i pT4: local recurrence-free survival; j positive lymph nodes: overall survival; (k) positive lymph nodes: progression-free survival; l positive lymph nodes: local recurrence-free survival; ELAPE: extralevator abdominoperineal excision; APE: abdominoperineal excision
Fig. 4
Fig. 4
Comparison of overall survival, progression-free survival and local recurrence between patients with or without neoadjuvant chemoradiotherapy who underwent ELAPE and APE procedures. a with neoadjuvant chemoradiotherapy: overall survival; b with neoadjuvant chemoradiotherapy: progression-free survival; c with neoadjuvant chemoradiotherapy: local recurrence-free survival; d without neoadjuvant chemoradiotherapy; e without neoadjuvant chemoradiotherapy: progression-free survival; f without neoadjuvant chemoradiotherapy: local recurrence
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