• Mads Klein, Anders Fischer, Jacob Rosenberg, Ismail Gögenur, and Danish Colorectal Cancer Group (DCCG).
• Department of Surgery D, Herlev Hospital, University of Copenhagen, Herlev Ringvej Herlev, Denmark.
• Ann. Surg.. 2015 May 1;261(5):933-8.

ObjectiveTo evaluate the oncological results and possible benefits associated with extralevatory abdominoperineal excision (ELAPE) when compared with conventional abdominoperineal excision (APE).BackgroundELAPE was introduced in 2007 with the purpose of reducing the rate of positive resection margins after resection of low rectal cancers. Preliminary studies have shown promising results. No large-scale or nationwide data have been presented.MethodsDatabase study based on data from the Danish Colorectal Cancer Group's prospective database. Data on all ELAPEs and APEs performed in Denmark in the period January 1, 2009, through August 2012 were retrieved and evaluated for differences in demography, tumor characteristics, and oncological results. Uni- and multivariate logistic regression analyses were performed to identify risk factors for resection with a positive circumferential resection margin (CRM+).ResultsA total of 554 patients were included, 301(54%) were operated by ELAPE; 253(46%) by APE. Sixty-three percent were men, median (interquartile range) age was 69 (61-76 years) years, and tumors removed had predominantly T-stages T2 and T3 (32% and 45%, respectively). Overall, CRM+ was found in 13% of patients. When divided according to type of procedure, we found no significant differences in demography and tumor T- and N-stages. Resections with a CRM+ were more common after ELAPE (16% vs 7%; P = 0.006). After uni- and multivariate logistic regression analyses, surgery by ELAPE remained a risk factor for a CRM+ [odds ratio, 2.59 (95% confidence interval, 1.31-5.12); P = 0.006).ConclusionsIn this nationwide study, resection of low rectal cancers by ELAPE did not improve short-term oncological results, when compared with conventional APE.

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