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Article: A systematic review of transabdominal levator division during abdominoperineal excision of the rectum (APER)

TitleA systematic review of transabdominal levator division during abdominoperineal excision of the rectum (APER)
Authors
KeywordsAbdominoperineal excision of the rectum (APER)
Anterior resection
Extralevator abdominoperineal excision (ELAPE)
Levator ani
Rectal cancer
Issue Date2017
PublisherSpringer-Verlag Italia Srl. The Journal's web site is located at http://www.springer.it/libri_libro.asp?id=248
Citation
Techniques in Coloproctology, 2017, v. 21 n. 9, p. 701-707 How to Cite?
AbstractBackground: The aim of the present study was to evaluate the surgical technique, short-term oncological and perioperative outcomes for the transabdominal division of the levator ani muscles during abdominoperineal excision of the rectum (APER). Methods: A systematic review was performed to identify studies reporting on transabdominal division of the levator ani during APER. A comprehensive literature search was performed using a combination of free-text terms and controlled vocabulary when applicable on the following databases: MEDLINE, EMBASE, Science Citation Index Expanded and Cochrane Central Register of Controlled Trials in the Cochrane Library. The search period was from January 1945 to December 2015. The following search headings were used: “transabdominal”, “transpelvic”, “abdominal” or “pelvic” combined with either “levator” or “extralevator” and with “abdominoperineal”. Results: Nine publications were identified reporting on 99 participants. The male/female distribution was 1.44:1, respectively, and the mean age was 56.6 (30–77) years. All tumours were less than 5 cm from the anal verge. The preoperative radiological staging was T2 in 18% of cases, T3 in 53.5% and T4 in 28.5%. Transabdominal division of the levators was performed laparoscopically in 55 cases, robotically in 34 and open in 10. The mean operating time was 255 (177–640) min. Mean intraoperative blood loss was 140 (92–500) ml. There were no conversions to open. Circumferential resection margins were positive in two cases, and there was one intraoperative perforation. Mean post-operative length of stay was 9.3 (3–67) days. Follow-up (from 0 to 31 months) revealed 19 perineal wound infections, 15 cases of sexual dysfunction and 7 cases of urinary retention. There was no mortality and 1 readmission. Conclusions: Transabdominal division of the levators during APER is feasible and reproducible, with acceptable perioperative and good early oncological outcomes. Further comparative studies are needed.
Persistent Identifierhttp://hdl.handle.net/10722/259523
ISSN
2023 Impact Factor: 2.7
2023 SCImago Journal Rankings: 0.878
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorBaird, DLH-
dc.contributor.authorSimillis, C-
dc.contributor.authorKontovounisios, C-
dc.contributor.authorSheng, Q-
dc.contributor.authorNikolaou, S-
dc.contributor.authorLaw, WL-
dc.contributor.authorRasheed, S-
dc.contributor.authorTekkis, PP-
dc.date.accessioned2018-09-03T04:09:16Z-
dc.date.available2018-09-03T04:09:16Z-
dc.date.issued2017-
dc.identifier.citationTechniques in Coloproctology, 2017, v. 21 n. 9, p. 701-707-
dc.identifier.issn1123-6337-
dc.identifier.urihttp://hdl.handle.net/10722/259523-
dc.description.abstractBackground: The aim of the present study was to evaluate the surgical technique, short-term oncological and perioperative outcomes for the transabdominal division of the levator ani muscles during abdominoperineal excision of the rectum (APER). Methods: A systematic review was performed to identify studies reporting on transabdominal division of the levator ani during APER. A comprehensive literature search was performed using a combination of free-text terms and controlled vocabulary when applicable on the following databases: MEDLINE, EMBASE, Science Citation Index Expanded and Cochrane Central Register of Controlled Trials in the Cochrane Library. The search period was from January 1945 to December 2015. The following search headings were used: “transabdominal”, “transpelvic”, “abdominal” or “pelvic” combined with either “levator” or “extralevator” and with “abdominoperineal”. Results: Nine publications were identified reporting on 99 participants. The male/female distribution was 1.44:1, respectively, and the mean age was 56.6 (30–77) years. All tumours were less than 5 cm from the anal verge. The preoperative radiological staging was T2 in 18% of cases, T3 in 53.5% and T4 in 28.5%. Transabdominal division of the levators was performed laparoscopically in 55 cases, robotically in 34 and open in 10. The mean operating time was 255 (177–640) min. Mean intraoperative blood loss was 140 (92–500) ml. There were no conversions to open. Circumferential resection margins were positive in two cases, and there was one intraoperative perforation. Mean post-operative length of stay was 9.3 (3–67) days. Follow-up (from 0 to 31 months) revealed 19 perineal wound infections, 15 cases of sexual dysfunction and 7 cases of urinary retention. There was no mortality and 1 readmission. Conclusions: Transabdominal division of the levators during APER is feasible and reproducible, with acceptable perioperative and good early oncological outcomes. Further comparative studies are needed.-
dc.languageeng-
dc.publisherSpringer-Verlag Italia Srl. The Journal's web site is located at http://www.springer.it/libri_libro.asp?id=248-
dc.relation.ispartofTechniques in Coloproctology-
dc.rightsThe final publication is available at Springer via http://dx.doi.org/[insert DOI]-
dc.subjectAbdominoperineal excision of the rectum (APER)-
dc.subjectAnterior resection-
dc.subjectExtralevator abdominoperineal excision (ELAPE)-
dc.subjectLevator ani-
dc.subjectRectal cancer-
dc.titleA systematic review of transabdominal levator division during abdominoperineal excision of the rectum (APER)-
dc.typeArticle-
dc.identifier.emailLaw, WL: lawwl@hkucc.hku.hk-
dc.identifier.authorityLaw, WL=rp00436-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1007/s10151-017-1682-0-
dc.identifier.pmid28891039-
dc.identifier.scopuseid_2-s2.0-85028999822-
dc.identifier.hkuros288550-
dc.identifier.volume21-
dc.identifier.issue9-
dc.identifier.spage701-
dc.identifier.epage707-
dc.identifier.isiWOS:000412976300003-
dc.publisher.placeItaly-
dc.identifier.issnl1123-6337-

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