Laparoscopic abdominoperineal excision with trans-abdominal individualized levator transection: interim analysis of a randomized controlled trial.
Colorectal Dis
; 19(7): O246-O252, 2017 Jul.
Article
en En
| MEDLINE
| ID: mdl-28477432
ABSTRACT
AIM:
Extralevator abdominoperineal excision (ELAPR) is challenging 'conventional' abdominoperineal excision (APR), yet the safety and efficacy of ELAPR is still under debate. We therefore developed a laparoscopic APR with trans-abdominal individualized levator transection (LAPR-TILT) approach and compared the outcome with a conventional laparoscopic APR (CLAPR).METHOD:
All eligible patients were entered a single-centre randomized controlled trial to compare CLAPR and LAPR-TILT. We assessed the first 185 patients, including operative findings, complications, histopathology and urogenital function.RESULTS:
Ninety-three patients in the CLAPR group and 92 patients in the APR-TILT group were included for analysis. The APR-TILT procedure took less time [137 (101-175) min vs 146 (102-187) min; P = 0.03], mainly owing to faster perineal dissection. APR-TILT resulted in a reduced rate of bowel perforation (1.1% vs 8.6%; P = 0.04), circumferential resection margin positivity (1.1% vs 10.8%; P = 0.01) and postoperative wound complications (5.4% vs 16.2%; P = 0.02) compared with the CLAPR procedure. At a median follow-up of 19 months after surgery, three patients (3.2%) in the CLAPR group had tumour recurrence while no tumour recurrence occurred in the LAPR-TILT group. Patients who underwent LAPR-TILT reported fewer urinary or sexual problems (LAPR-TILT vs CLAPR, 10.9% vs 24.7% and 17.4% vs 38.7%, respectively).CONCLUSION:
Compared with CLAPR, LAPR-TILT achieved better pathological results for factors that are surrogate parameters for local recurrence. LAPR-TILT could also reduce the risk of urogenital dysfunction.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Perineo
/
Neoplasias del Recto
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Laparoscopía
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Disección
/
Abdomen
Tipo de estudio:
Clinical_trials
/
Etiology_studies
Límite:
Aged
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Colorectal Dis
Asunto de la revista:
GASTROENTEROLOGIA
Año:
2017
Tipo del documento:
Article
País de afiliación:
China