Which surgical technique has the best outcome for patients with low rectal cancer?

This study compared the outcomes of two surgical techniques in patients with low rectal cancer. 

Surgery is the main option for curing patients with low rectal cancer. The standard type of surgery, abdominoperineal excision, involves removal of the lower rectum and a small amount of surrounding tissue. Extralevator abdominoperineal excision (ELAPE) is a newer version of this surgery. ELAPE involves removing a larger amount of tissue surrounding the lower rectum. ELAPE is becoming more common as it is thought to improve patient recovery and decrease complications.

It has also been reported to reduce the risk of positive circumferential resection margins (CRM). 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 combined results from previous studies to compare the outcome of patients after ELAPE or standard surgery. Three to six studies were used to analyze the risk of intraoperative tumor perforations (a hole forming in the tumor during surgery), wound complications, positive CRMs and cancer relapse after surgery. The length of hospital stay and quality of life after surgery were also analyzed.

Patients who underwent standard surgery had 4.3-fold higher odds of having intraoperative tumor perforation than patients who underwent ELAPE. They also had 2.52 times the odds of the cancer returning near the original site and 2.9 times the odds of having positive CRMs.

Patients who had ELAPE surgery had a significantly shorter average hospital stay. However, patients who underwent standard surgery had 38% lower odds of having wound complications near the anus compared to patients who had ELAPE surgery.

The authors concluded that there are some advantages to ELAPE over standard surgery. Patients had shorter hospital stays, a lower risk of relapse and a lower risk of positive CRMs.