Results of extralevator abdominoperineal resection for low rectal cancer including quality of life and long-term wound c
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ORIGINAL ARTICLE
Results of extralevator abdominoperineal resection for low rectal cancer including quality of life and long-term wound complications Thilo Welsch & Vyron Mategakis & Pietro Contin & Yakup Kulu & Markus W. Büchler & Alexis Ulrich
Accepted: 5 November 2012 / Published online: 21 November 2012 # Springer-Verlag Berlin Heidelberg 2012
Abstract Purpose Extralevator abdominoperineal resection (APR) for low rectal cancer has been adopted by centers to improve oncological outcome. The present study aimed to investigate oncological results, wound complications, and quality of life (QoL). Methods Patients who underwent extralevator APR for rectal cancer between 2007 and 2011 were identified retrospectively. QoL status was assessed using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-CR30 and CR29 questionnaires. Results Thirty laparoscopic (n07) or open (n023) extralevator APRs were performed in 17 male and 13 female patients. The mortality was zero; circumferential margin involvement occurred in two cases (6.7 %); and there was no bowel perforation. No local recurrence was noted after a median follow-up of 28.3 months; however, six patients died, and eight developed distant metastases. Perineal wound complications were found in 46.6 % of patients, and all were managed conservatively. Fifty percent of the patients reported persistent perineal pain at the follow-up exam. QoL was assessed 7 to 46 months after surgery, and the global health status (70.6) was comparable to the EORTC reference group and published conventional APR series. The QLQ-CR29 module revealed high mean symptom scores for urinary frequency (48.1), incontinence (30.5), and impotence (79.1). Conclusions Extralevator APR can control local recurrence but not distant metastases of low rectal cancer. The extended Thilo Welsch and Vyron Mategakis contributed equally to this study. T. Welsch : V. Mategakis : P. Contin : Y. Kulu : M. W. Büchler : A. Ulrich (*) Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany e-mail: [email protected]
perineal resection appears not to decrease general QoL, but it results in a high rate of perineal wound complications. Genitourinary functions are often impaired, even in the long term, and further improvements to the technique must seek to reduce genitourinary harm. Keywords Rectal cancer . Abdominoperineal resection . Extralevator . Quality of life . Wound complications
Introduction The standard operative procedure for rectal cancers of the upper and middle thirds of the rectum is the anterior resection. The introduction of the total mesorectal excision (TME) set a milestone in oncological surgery and led to a significant reduction in local recurrence after curative resection [1–3]. Abdominoperineal resection (APR) is indicated if sphincter preservation by anterior resection cannot be achieved for tumors in the lower third of the rectum. With conventional (or standard) APR, the peri
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