Newer surgical method improves the outcome of patients with low rectal cancer

This study compared two surgical techniques in terms of short-term recovery and long-term outcome of low rectal cancer (tumor located in the lowest third of the rectum).

Surgery, or surgery combined with chemoradiatherapy or radiotherapy, is often the only curative option for patients with rectal cancer. The most commonly used surgical technique is abdominoperineal excision (APE), which involves removal of the tumor and a surrounding “waist” zone. A newer surgical method has recently been developed known as extralevator abdominoperineal excision (ELAPE).

ELAPE involves removing a full cylindrical piece of rectum surrounding the tumor. ELAPE is becoming more common as it is thought to improve patient recovery from surgery and minimize surgical complications. It is also reported to reduce the risk of positive circumferential resection margins (CRM). The CRM refers to the distance between the tumor and a part of the rectum known as the mesorectal fascia. The mesorectal fascia is an area of fatty tissue that holds blood vessels and nerves, and is found surrounding the rectum. Positive CRMs predict worse outcomes for patients.

This study reviewed previous publications and combined all the previous results (meta-analysis) from studies that compared ELAPE and APE. In total 8 studies, including 949 patients were included in the results. 496 patients had received ELAPE surgery and 453 patients had received APE surgery. Patient outcomes included; positive CRM, the risk of local recurrence (return of the cancer after its removal), intraoperative bowel perforation (the formation of a hole in the intestine) and general surgical complications.

Patients receiving ELAPE had lower local recurrence rates, positive CRM rates, and intraoperative bowel perforation rates compared to APE. ELAPE decreased the risk of local recurrence by 68% compared to APE. It also decreased the risk of intraoperative bowel perforation by 66% and the risk of having positive CRM by 56% compared to APE.

ELAPE surgery did take significantly longer to perform, however, patients had a shorter hospital stay after ELAPE surgery. There were no differences in wound healing, wound infections, urinary problems, urinary infections or sexual problems between the two types of surgery.

The authors concluded that ELAPE has a lower intraoperative bowel perforation rate, positive CRM rate, and local recurrence rate than APE. There is also evidence that in selected low rectal cancer patients, ELAPE is a more efficient and equally safe option to replace APE.