ABSTRACT
BACKGROUND: Abdominal perineal excision (APE) has been associated with a high risk of positive circumferential resection margin (CRM+) and local recurrence rates in the treatment of rectal cancer. An alternative extralevator approach (ELAPE) has been suggested to improve the quality of resection by avoiding coning of the specimen decreasing the risk of tumor perforation and CRM+. The aim of this study is to compare the quality of the resected specimen and postoperative complication rates between ELAPE and "standard" APE. METHODS: All patients between 1998 and 2014 undergoing abdominal perineal excision for primary or recurrent rectal cancer at a single Institution were reviewed. Between 1998 and 2008, all patients underwent standard APE. In 2009 ELAPE was introduced at our Institution and all patients requiring APE underwent this alternative procedure (ELAPE). The groups were compared according to pathological characteristics, specimen quality (CRM status, perforation and failure to provide the rectum and anus in a single specimen-fragmentation) and postoperative morbidity. RESULTS: Fifty patients underwent standard APEs, while 22 underwent ELAPE. There were no differences in CRM+ (10.6 vs. 13.6%; p = 0.70) or tumor perforation rates (8 vs. 0%; p = 0.30) between APE and ELAPE. However, ELAPE were less likely to result in a fragmented specimen (42 vs. 4%; p = 0.002). Advanced pT-stage was also a risk factor for specimen fragmentation (p = 0.03). There were no differences in severe (Grade 3/4) postoperative morbidity (13 vs. 10%; p = 0.5). Perineal wound dehiscences were less frequent among ELAPE (52 vs 13%; p < 0.01). Despite short follow-up (median 21 mo.), 2-year local recurrence-free survival was better for patients undergoing ELAPE when compared to APE (87 vs. 49%; p = 0.04). CONCLUSIONS: ELAPE may be safely implemented into routine clinical practice with no increase in postoperative morbidity and considerable improvements in the quality of the resected specimen of patients with low rectal cancers.
Subject(s)
Rectal Neoplasms/surgery , Abdomen , Adult , Aged , Chemoradiotherapy, Adjuvant , Female , Humans , Male , Margins of Excision , Middle Aged , Neoadjuvant Therapy/methods , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/surgery , Neoplasm Recurrence, Local/therapy , Perineum/surgery , Postoperative Complications , Rectal Neoplasms/pathology , Rectal Neoplasms/therapy , Risk Factors , Treatment OutcomeABSTRACT
La eliminación quirúrgica del tejido gingival hiperplásico se ha realizado durante mucho tiempo con la técnica convencional de bisel externo provocado un exceso de sangrado y retardo en la cicatrización. Algunos autores recomiendan el uso del electrobisturí como una mejor opción y mencionan no tener problemas en la cicatrización ni complicaciones durante el tratamiento. Se realiza un estudio comparativo con las dos técnicas mencionadas a fin de establecer la diferencia
Subject(s)
Humans , Electrosurgery/instrumentation , Electrosurgery , Gingival Hyperplasia/surgeryABSTRACT
Se realizaron 54 tratamientos de eliminación melánica fisiológica gingival; 10 pacientes mostraron repigmentación clínica leve al término de un año del tratamiento. Ocho de estos individuos resultaron ser fumadores crónicos. El método mucoabrasivo es una técnica quirúrgica sencilla sin grandes riesgos; se trató la región anterosuperior e inferior debido a que es el área de la sonrisa y afecta estética y psicológicamente.