Laparoscopic abdominoperineal excision with trans‐abdominal individualized levator transection: interim analysis of a randomized controlled trial. (July 2017)

• Record Type: Journal Article
• Authors: Feng, B.; Lu, J.; Zhang, S.; Yan, X.; Li, J.; Xue, P.; Wang, M.; Lu, A.; Ma, J.; Zang, L.; Dong, F.; He, Z.; Yue, F.; Sun, J.; Hong, X.; Zheng, M.
• Is Part Of: Colorectal disease. Volume 19:Number 7(2017)
• Page Start: O246
• Page End: O252
• Publication Date: 2017-07
• Subjects: Low rectal cancer -- abdominoperineal excision -- levator muscle -- laparoscopic surgery -- individualized surgery; Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.13711
• Languages: English
• ISSNs: 1462-8910

Abstract

Abstract: Aim: Extralevator abdominoperineal excision (ELAPR) is challenging 'conventional' abdominoperineal excision (APR), yet the safety and efficacy of ELAPR is still under debate. We therefore developed a laparoscopic APR with trans‐abdominal individualized levator transection (LAPR‐TILT) approach and compared the outcome with a conventional laparoscopic APR (CLAPR). Method: All eligible patients were entered a single‐centre randomized controlled trial to compare CLAPR and LAPR‐TILT. We assessed the first 185 patients, including operative findings, complications, histopathology and urogenital function. Results: Ninety‐three patients in the CLAPR group and 92 patients in the APR‐TILT group were included for analysis. The APR‐TILT procedure took less time [137 (101–175) min vs 146 (102–187) min; P = 0.03], mainly owing to faster perineal dissection. APR‐TILT resulted in a reduced rate of bowel perforation (1.1% vs 8.6%; P = 0.04), circumferential resection margin positivity (1.1% vs 10.8%; P = 0.01) and postoperative wound complications (5.4% vs 16.2%; P = 0.02) compared with the CLAPR procedure. At a median follow‐up of 19 months after surgery, three patients (3.2%) in the CLAPR group had tumour recurrence while no tumour recurrence occurred in the LAPR‐TILT group. Patients who underwent LAPR‐TILT reported fewer urinary or sexual problems (LAPR‐TILT vs CLAPR, 10.9% vs 24.7% and 17.4% vs 38.7%, respectively). Conclusion: Compared with CLAPR, LAPR‐TILT achieved better pathological results for factors that are surrogate parameters for local recurrence. LAPR‐TILT could also reduce the risk of urogenital dysfunction.