Extralevator APR (ELAPE)
Journal
Surgical Treatment of Colorectal Cancer: Asian Perspectives on Optimization and Standardization
ISBN
9789811051432
Date Issued
2018-05-02
Author(s)
Abstract
© Springer Nature Singapore Pte Ltd. 2018. All rights reserved. Extralevator APR has become a popular procedure for patients with distal rectal cancer requiring an APR procedure. In contrast to conventional APR, extralevator APR is characterized by that the dissection of levators is performed close to their attachment on the lateral pelvic sidewall, thus making the resected anorectal specimen cylindrical rather than with a waist in shape. Technically, extralevator APR would seem to be probably more effective in reducing the positivity of circumferential resection margin and intraoperative rectal perforation but is associated with the disadvantage of more extensive tissue removal from around the anorectum, which leaves a large cavity to close. To date, systematic reviews and meta-analyses comparing extralevator APR with conventional APR were inconclusive. In this chapter, we present the knack and pitfall in performing the extralevator APR. In our view, although the evidences for the oncologic superiority of extralevator APR are still weak, it does benefit for some carefully selected patients with locally invasive diseases.
Subjects
Extralevator APR
Type
book part