• Mattias Prytz, Eva Angenete, Jan Ekelund, and Eva Haglind.
• Department of Surgery, NU Hospital Group, Trollhättan, Sweden, mattias.prytz@vgregion.se.
• Int J Colorectal Dis. 2014 Aug 1; 29 (8): 981-7.

PurposeLocal recurrences are more common after abdominoperineal excision (APE) than after anterior resection of rectal cancer. Extralevator APE was introduced to address this problem. This prospective registry-based population study aims to investigate the efficacy of extralevator APE (ELAPE) in improving short-term oncological outcome.MethodsAll Swedish patients operated with any kind of abdominoperineal excision and registered in the Swedish Rectal Cancer Registry 2007-2009 were included (n = 1,397) and analyzed with emphasis on the perineal part of the operation. Short-term perioperative and oncological results were collected from the registry.ResultsExtralevator APE did not result in fewer intraoperative perforations or involved circumferential resection margins as compared to standard APE for the entire group. Intraoperative perforations were significantly fewer for patients with low tumours (≤4 cm) (ELAPE: n = 28/386 versus APE: n = 9/58) (p = 0.043) and for early (T0-T2) T-stages (ELAPE: n = 3/172 versus APE: n = 6/75) (p = 0.025). There were significantly more post-operative wound infections for ELAPE than for APE (n = 106 (20.4 %) versus n = 25 (12.0 %), p = 0.011).ConclusionsThe short-term results indicate that selective use of extralevator APE can be warranted, for example, for subgroups with low tumours. In conclusion, selective use of the extralevator APE is advocated as not all patients seem to benefit from the technique, and there are significantly more short-term complications after extralevator APE.

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