This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Multicentre propensity score‐matched analysis of conventional versus extended abdominoperineal excision for low rectal cancer. BJS 2014; 101: 874-882.

Published: 12th May 2014

Authors: H. Ortiz, M. A. Ciga, P. Armendariz, E. Kreisler, A. Codina‐Cazador, J. Gomez‐Barbadillo et al.

Background

Abdominal perineal excision (APE) was originally described with levator ani removal for rectal cancer. An even wider, more aggressive extralevator resection for APE has been proposed. Although some surgeons are performing a very wide ‘extralevator APE (ELAPE)’, there are few data to recommend it routinely. This multicentre study aimed to compare outcomes of APE and ELAPE.

Method

A multicentre propensity case‐matched analysis comparing two surgical approaches (APE and ELAPE) was performed. All patients who underwent abdominoperineal resection of a rectal tumour were considered for the analysis. Tumour height was defined by magnetic resonance imaging measurement and patients with stage II–III tumours had neoadjuvant radiochemotherapy. Involvement of the circumferential resection margin (CRM) and intraoperative tumour perforation were the main outcome measures. A logistic regression model was used to study the relationship between the surgical approaches and outcomes.

Results

From January 2008 to March 2013 a total of 1909 consecutive patients underwent APE or ELAPE, of whom 914 matched patients (457 in each group) formed the cohort for analysis. Intraoperative tumour perforation occurred in 7·9 and 7·7 per cent of patients during APE and ELAPE respectively (P = 0·902), and there was CRM involvement in 13·1 and 13·6 per cent (P = 0·846). There were no differences between APE and ELAPE in terms of postoperative complication rates (52·3 versus 48·1 per cent; P = 0·209), need for reoperation (7·7 versus 7·0 per cent; P = 0·703), perineal wound problems (26·0 versus 21·9 per cent; P = 0·141), mortality rate (2·0 versus 2·0 per cent; P = 1·000) and local recurrence rate at 2 years (2·7 versus 5·6 per cent; P = 0·664).

Conclusion

ELAPE does not improve rates of CRM involvement, intraoperative tumour perforation, local recurrence or mortality.

Full text

You may also be interested in

Original article

Early MRI predictors of disease‐free survival in locally advanced rectal cancer from the GRECCAR 4 trial. BJS 2019; 106: 1530-1541.

Authors: S. Nougaret, F. Castan, H. Forges, H. A. Vargas, B. Gallix, S. Gourgou et al.

Original article

Secondary technical resectability of colorectal cancer liver metastases after chemotherapy with or without selective internal radiotherapy in the randomized SIRFLOX trial.

Authors: B. Garlipp, P. Gibbs, G. A. Van Hazel, R. Jeyarajah, R. C. G. Martin, C. J. Bruns et al.

Original article

Population‐based study of the impact of small bowel obstruction due to adhesions on short‐ and medium‐term mortality.

Authors: R. Behman, A. B. Nathens, B. Haas, N. Look Hong, P. Pechlivanoglou, P. Karanicolas et al.

Original article

Prospective cohort study of appendicectomy for treatment of therapy‐refractory ulcerative colitis.

Authors: M. E. Stellingwerf, S. Sahami, D. C. Winter, S. T. Martin, G. R. D'Haens, G. Cullen et al.

Original article

Long‐term follow‐up of the AVOD randomized trial of antibiotic avoidance in uncomplicated diverticulitis. BJS 2019; 106: 1542-1548.

Authors: D. Isacson, K. Smedh, M. Nikberg, A. Chabok

Original article

Pushing the boundaries of pelvic exenteration by maintaining survival at the cost of morbidity. BJS 2019; 106: 1393-1403.

Authors: R. L. Venchiarutti, M. J. Solomon, C. E. Koh, J. M. Young, D. Steffens

Systematic review

Meta‐analysis of the role of colonoscopy after an episode of left‐sided acute diverticulitis. BJS 2019; 106: 988-997.

Authors: S. J. Rottier, S. T. Dijk, A. A. W. Geloven, W. H. Schreurs, W. A. Draaisma, W. A. Enst et al.

Randomized clinical trial

Multicentre randomized clinical trial of colonic J pouch or straight stapled colorectal reconstruction after low anterior resection for rectal cancer.

Authors: S. Pucciarelli, P. Del Bianco, U. Pace, F. Bianco, A. Restivo, I. Maretto et al.

Randomized clinical trial

Randomized clinical trial of accelerated enhanced recovery after minimally invasive colorectal cancer surgery (RecoverMI trial). BJS 2019; 106: 1311-1318.

Authors: B. K. Bednarski, T. P. Nickerson, Y. N. You, C. A. Messick, B. Speer, V. Gottumukkala et al.

Review

Mechanisms of immunogenicity in colorectal cancer. BJS 2019; 106: 1283-1297.

Authors: T. O. Sillo, A. D. Beggs, D. G. Morton, G. Middleton

Systematic review

Meta‐analysis of the effect of extending the interval after long‐course chemoradiotherapy before surgery in locally advanced rectal cancer. BJS 2019; 106: 1298-1310.

Authors: É. J. Ryan, D. P. O'Sullivan, M. E. Kelly, A. Z. Syed, P. C. Neary, P. R. O'Connell et al.

Original article

Postoperative complications in relation to overall treatment time in patients with rectal cancer receiving neoadjuvant radiotherapy.

Authors: J. Erlandsson, D. Pettersson, B. Glimelius, T. Holm, A. Martling