• Eun Jung Park, Seung Hyuk Baik, Jeonghyun Kang, Hyuk Hur, Byung Soh Min, Kang Young Lee, Nam Kyu Kim, and Seung-Kook Sohn.
• Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
• Surg Endosc. 2016 Apr 1; 30 (4): 1672-82.

BackgroundExtralevator abdominoperineal resection had oncologic superiority with reduced local recurrence and improving survival rates. However, extended perineal resection resulted in complicated perineal reconstructions. Therefore, a new surgical technique to overcome previous limitations is required. This study aims to demonstrate a surgical procedure and outcomes of the modified extralevator abdominoperineal resection, which satisfies both an extended cylindrical resection and a convenient perineal wound closure by modification of the surgical dissection plane.MethodsFrom September 2011 to February 2014, 12 consecutive patients (five males and seven females) who underwent the modified extralevator abdominoperineal resection for low rectal cancer were evaluated. Intraoperative and postoperative outcomes were assessed. Pathologic outcomes were evaluated for the oncologic results.ResultsThe mean age was 55.3 ± 15.1 years, and body mass index was 21.8 ± 3.1 kg/m(2). Ten patients (83.3%) received preoperative chemoradiotherapy. The operations were performed by five cases of laparoscopic surgery, six cases of open surgery and one case of robotic surgery. The mean operation time was 258.8 ± 58.0 min. There were no conversions and no tumor perforations. Days to first soft diet was 4.7 ± 3.4 days, and the mean hospital stay was 11.2 ± 4.7 days. Postoperative complications were two cases of grade I, two cases of grade II and one case of grade III. There was one patient (8.3%) with a positive circumferential resection margin, and there was one case of local recurrence.ConclusionsThe modified extralevator abdominoperineal resection was feasible and safe for patients with low rectal cancer with extended perineal dissection and convenient direct wound closure.

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