Extralevator abdominoperineal excision versus conventional surgery for low rectal cancer: a single surgeon experience Alt yerleşimli rektal kanserlerde ekstralevator abdominoperineal eksizyon ile klasik cerrahinin karşılaştırılması: Tek cerrah deneyimi

INTRODUCTION As originally described by Miles (1), abdominoperineal excision (APE) has long been the standard treatment for tumors of the middle and lower rectum. It achieves the greatest possible distal margin of resection by removing the anus in continuity with the rectum. Total mesorectal excision (TME), recommended by Heald et al. (2), has led to a decrease in perineal amputation numbers and has become the oncologic standard in the last 30 years. However, the rates of circumferential resection margin (CRM) positivity and of intraoperative perforation (IOP) is higher in abdominoperineal excision as compared to anterior excision. Recently, Holm’s studies have generated a renewed interest on the abdominoperineal excision technique (3). In this operation, the levator muscles are excised from their origins on the pelvic side walls and removed en bloc with the tumor. The aim of this approach is to reduce both the rate of CRM positivity and IOP, which are associated with high rates of local recurrence and poor survival outcomes in patients with rectal cancer (4-8). Although there are many similarities between what Miles has previously described and what Holm recently defined, there are major differences that should be recognized e.g. Miles did not use the prone position and did not undertake a total mesorectal excision. This study was designed to compare the results of extralevator abdominoperineal excision (ELAPE) with the conventional APE approach. 244 Gürel Neşşar1, Ali Eba Demirbağ1, Bahadır Celep2, Orhan Hayri Elbir1, Cüneyt Kayaalp3