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PWE-387 Role of technique of abdomino-perineal excision of rectum on perineal complications and interventions - our experience
  1. HD Thirkettle,
  2. PC Munipalle,
  3. DFN Fung,
  4. DW Borowski,
  5. DK Garg,
  6. MA Tabaqchali,
  7. TS Gill,
  8. AK Agarwal
  1. General Surgery, University Hospital of North Tees and Hartlepool, Stockton on Tees, UK


Introduction Oncological outcome from Extra-Levator Abdomino-Perineal Excision of low rectal cancers (ELAPE) have been shown to be superior to those achieved by conventional APER. However, it usually requires some form of pelvic floor repair due to the larger defect, and it has been suggested that ELAPE carries a higher morbidity particularly in view to pelvic floor complications. We examined results and outcomes from ELAPE and APER in our institution.

Method All non-restorative excisions of primary low rectal cancers in a single colorectal unit between 2009 and 2014 were retrospectively examined, using data from healthcare records, pathology records and administrative databases. End points for analysis included duration of hospital stay following index surgery, rates of immediate (≤ 30 days) and late post-operative complications, re-admission rates, re-interventions and perineal hernia rates.

Results A total of 44 patients underwent non-restorative excision of a rectal cancer (26 ELAPE and 18 APER), with a median follow up period of 30 months. There was no difference between the groups for age, gender, BMI, and rates of pre-operative neo-adjuvant treatment. However, there were more UICC stage III cancers in the ELAPE group compared to APER (5/26 [19.2%] vs. 11/18 [61.1%], p = 0.035). The median length of stay was similar in both groups (7.5 days, p = 0.44), and there was no difference between ELAPE and APER for early complication (12/26 [46.2%] vs. 7/18 [38.9%], p = 0.632), re-intervention (12/26 [46.2%] vs. 3/18 [16.7], p = 0.078), readmission (8/26 [30.8%] vs. 1/18 [5.6%], p = 0.071), and perineal hernia rates (1/26 [3.8%] vs. 1/18 [5.6%], p = 0.474). However, late perineal complications were more common in ELAPE (17/26 [65.4%] vs. 2/18 [11.1%], p < 0.001) and required intervention (11/26 [42.3%] vs. 1/18 {[5.6%], p = 0.007). Other factors associated with late complications included neo-adjuvant treatment (18/34 [52.9%] vs. 1/10 (10.0%], p = 0.016), CRM positivity (5/6 [83.3%] vs. 13/36 [36.1%], p = 0.095) and use of mesh for perineal repair (17/29 [58.6%] vs. 2/13 [15.4%], p = 0.009). Within ELAPE, there was no difference in complications between biological and synthetic mesh groups.

Conclusion ELAPE appears to have no increased short-term morbidity compared to conventional APER, but late complication rates are higher. This may be, in part, explained by tumour factors, use of neo-adjuvant treatment and the use of mesh for reconstruction in this group. Selective use of ELAPE for non-restorative excision of a rectal cancer is advised, and the role of flap reconstruction may need to be considered in more patients.

Disclosure of interest None Declared.

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