EXTRALEVATOR ABDOMINOPERINEAL EXCISION OF THE RECTUM: SHORT-TERM OUTCOMES IN COMPARISON WITH CONVENTIONAL SURGERY

AIM. To сотраге short-term outcomes of extralevator abdominoperineal excision (ELAPE) of the rectum with laparoscopic and open abdominаl approach and a conventional abdominoperineal excision (APE). METHODS. А total of 90 patents who underwent APE for low rectal cancer were screened between 2013 and 2015. Patients of the first group (group I, n=42) underwent ELAPE: subgroup 1а (n=18) -with laparoscopic abdominаl approach, 1b (n=24) - llaparotomy; patients of the second group (group 2,n=48) - conventional APE. RESULTS. The operation time for the group 1 was 250,2± 73,8 min vs 155,9 ± 28,4 min for the group 2 (p<0,001). There were significant differences betweensubgroup 1a and subgroup 1b and group 2 in terms of blood loss (193,4± 97,6 ml vs 307,1 ± 58,4 and 322,3 ± 175,4 ml). The postoperative complications rate was lower in the group 1 compared with the group 2 (7,1 % vs 22,9 %, p=0.03).Compared with APE with open abdominаl approach (subgroup Ib and group II), laparoscopic ELAPE patients demonstrated less need in postoperative analgesia and shorter postoperative recovery period.. The rates of inadvertent intra operative bowel perforation in the group I was significantly lower than it was in the group II (2,4 vs 16,7%, p=0,024).The circumferential resection margin involvement rate was lower in the ELAPE group compared with the conventional APE group (4,8 % vs 22,9 %, p=0,015). CONCLUSION: The ELAPE for rectal cancer patients is safe, and is associated with lower postoperative complications rate, circumferential resection margin involvement rate, and intraoperative bowel perforation rate compared with the conventional APE group. Laparoscopic ELAPE has advantages in operative blood loss, duration postoperative analgesia and postoperative recovery over ELAPE and conventional APE with open abdominаl approach.

Rectal cancer, Surgical treatment, Extralevator abdominoperineal excision, Short-term outcomes

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