Extralevator vs conventional abdominoperineal resection for rectal cancer-A systematic review and meta-analysis

Ionut Negoi; Sorin Hostiuc; Sorin Paun; Ruxandra I Negoi; Mircea Beuran

doi:10.1016/j.amjsurg.2016.02.022

Extralevator vs conventional abdominoperineal resection for rectal cancer-A systematic review and meta-analysis

Am J Surg. 2016 Sep;212(3):511-26. doi: 10.1016/j.amjsurg.2016.02.022. Epub 2016 May 11.

Authors

Ionut Negoi¹, Sorin Hostiuc², Sorin Paun³, Ruxandra I Negoi⁴, Mircea Beuran³

Affiliations

¹ General Surgery Department, Carol Davila University of Medicine and Pharmacy Bucharest, No. 37 Dionisie Lupu Street, Sector 2, 020021, Bucharest, Romania; General Surgery Department, Emergency Hospital of Bucharest, Bucharest, Romania. Electronic address: negoiionut@gmail.com.
² General Surgery Department, Carol Davila University of Medicine and Pharmacy Bucharest, No. 37 Dionisie Lupu Street, Sector 2, 020021, Bucharest, Romania; National Institute of Legal Medicine Mina Minovici, Bucharest, Romania.
³ General Surgery Department, Carol Davila University of Medicine and Pharmacy Bucharest, No. 37 Dionisie Lupu Street, Sector 2, 020021, Bucharest, Romania; General Surgery Department, Emergency Hospital of Bucharest, Bucharest, Romania.
⁴ Anatomy Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

PMID: 27317475
DOI: 10.1016/j.amjsurg.2016.02.022

Abstract

Background: The aim of this study was to compare the short-term morbidity and long-term oncologic benefits of extralevator abdominoperineal excision (ELAPE) with conventional abdominoperineal resection (CAPR) for patients with rectal cancer.

Methods: Electronic search of the Cochrane Library, MEDLINE, EMBASE, Korean Journal, and J-EAST database from 2007 until August 2015 was carried out. We considered randomized controlled trials and nonrandomized comparative studies comparing ELAPE with CAPR to be eligible, if they included patients with rectal cancers.

Results: A total of 1 randomized controlled trials and 10 nonrandomized comparative studies met the inclusion criteria, involving 1,736 patients in the ELAPE group and 1,320 in the CAPR group. The ELAPE was associated with a significantly lower intraoperative perforation rate. There were no differences regarding the circumferential margin involvement, R0 resections, and local recurrence rate. There was less blood loss in ELAPE patients.

Conclusions: The ELAPE significantly lowered the intraoperative perforation rate, with no benefits regarding circumferential resection margin involvement and local recurrence rate.

Keywords: Conventional abdominoperineal resection; Extralevator abdominoperineal resection; Meta-analysis; Rectal cancer.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Abdomen / surgery*
Digestive System Surgical Procedures / methods*
Humans
Perineum / surgery*
Rectal Neoplasms / surgery*
Treatment Outcome