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Cylindrical abdominoperineal

Yue Yang, Huirong Xu, Zhenhua Shang, Shouzhen Chen, Fan Chen, Qiming Deng, Li Luo, Liang Zhu, Benkang Shi
OBJECTIVE: A meta-analysis was undertaken to provide an evidence-based basis of clinical trials comparing extralevator abdominoperineal excision with conventional abdominoperineal excision for low rectal tumor. METHODS: We searched through the major medical databases such as PubMed, EMBASE, Medline, Science Citation Index, Web of Science for all published studies without any limit on language from January 2009 until January 2015. The following search terms were used: extralevator abdominoperineal excision or cylindrical abdominoperineal resection or conventional abdominoperineal excision or abdominoperineal excision or rectal cancer...
2015: International Journal of Clinical and Experimental Medicine
A C Kraima, N P West, D Treanor, D Magee, N Roberts, C J H van de Velde, M C DeRuiter, P Quirke, H J T Rutten
AIM: Dissection of the perineal body (PB) during abdominoperineal excision (APE) for low rectal cancer is often difficult due to the lack of a natural plane of dissection. Understanding the PB and its relation to the anorectum is essential to permit safe dissection during the perineal phase of the operation and avoid damage to the anorectum and urogenital organs. This study describes the anatomy and histology of the PB relevant to APE. METHOD: Six human adult cadaver pelvic exenteration specimens (three male, three female) from the Leeds GIFT Research Tissue Programme were studied...
July 2016: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Puneet Singh, Edward Teng, Lisa M Cannon, Brian L Bello, David H Song, Konstantin Umanskiy
BACKGROUND: Extralevator abdominoperineal excision for distal rectal cancers involves cylindrical excision of the mesorectum with wide division of the levator ani muscles. Although this technique has been shown to decrease local cancer recurrence and improve survival, it leaves the patient with a considerable pelvic floor defect that may require reconstruction. OBJECTIVE: We developed an innovative technique of robotic extralevator abdominoperineal excision combined with robotic harvest of the rectus abdominis muscle flap for immediate reconstruction of the pelvic floor defect...
September 2015: Diseases of the Colon and Rectum
Eun Jung Park, Seung Hyuk Baik, Jeonghyun Kang, Hyuk Hur, Byung Soh Min, Kang Young Lee, Nam Kyu Kim, Seung-Kook Sohn
BACKGROUND: Extralevator abdominoperineal resection had oncologic superiority with reduced local recurrence and improving survival rates. However, extended perineal resection resulted in complicated perineal reconstructions. Therefore, a new surgical technique to overcome previous limitations is required. This study aims to demonstrate a surgical procedure and outcomes of the modified extralevator abdominoperineal resection, which satisfies both an extended cylindrical resection and a convenient perineal wound closure by modification of the surgical dissection plane...
April 2016: Surgical Endoscopy
Sung U Bae, Avanish P Saklani, Hyuk Hur, Byung S Min, Seung H Baik, Nam K Kim
BACKGROUND: Extralevator abdominoperineal resection (APR) in a prone jackknife position was developed to avoid a positive circumferential resection margin, and its application led to lower rates of local recurrence. The paper describes a technique of robotic extralevator APR with transabdominal levator division followed by pelvic floor reconstruction with bilayered composite mesh. METHODS: A 42-year-old man with low rectal cancer required APR that was performed in a lithotomy position with transabdominal division of the levators...
November 6, 2014: International Journal of Medical Robotics + Computer Assisted Surgery: MRCAS
José Reinan Ramos, Eduardo Parra-Davila
The authors present the four-arm single docking full robotic surgery to treat low rectal cancer. The eight main operative steps are: 1- patient positioning; 2- trocars set-up and robot docking; 3- sigmoid colon, left colon and splenic flexure mobilization (lateral-to-medial approach); 4-Inferior mesenteric artery and vein ligation (medial-to-lateral approach); 5- total mesorectum excision and preservation of hypogastric and pelvic autonomic nerves (sacral dissection, lateral dissection, pelvic dissection); 6- division of the rectum using an endo roticulator stapler for the laparoscopic performance of a double-stapled coloanal anastomosis (type I tumor); 7- intersphincteric resection, extraction of the specimen through the anus and lateral-to-end hand sewn coloanal anastomosis (type II tumor); 8- cylindric abdominoperineal resection, with transabdominal section of the levator muscles (type IV tumor)...
May 2014: Revista do Colégio Brasileiro de Cirurgiões
Jin C Kim, Jae Y Kwak, Yong S Yoon, In J Park, Chan W Kim
PURPOSE: This study was to ascertain whether a robot-assisted (RA) approach to APR might facilitate a cylindrical APR by enabling a deeper pelvic dissection during an abdominal approach, concurrently comparing the feasibility and short-term oncologic outcomes. METHODS: Forty-eight consecutive patients with lower rectal cancer who had undergone curative APR (21 RA vs. 27 open) were prospectively enrolled. The short-term operative outcomes and oncologic feasibility were evaluated and compared...
August 2014: International Journal of Colorectal Disease
Blas Flor-Lorente, Matteo Frasson, Erick Montilla
The Miles operation is every day more in the limelight. The abdominoperineal resection compared to anterior resection results in increased rate of circumferential resection margin (CRM) infiltration, increased iatrogenic tumor perforation rate and poorer quality of the mesorectum. These worse results may be caused by excessive dissection between the distal mesorectum and the plane of the levator ani and the consequent "resection waist" or "cone" effect in the specimen. A wider excision of the pelvic floor muscles, known as extraelevator abdominoperineal resection (ELAPE), would provide a "cylindrical" specimen which would hypothetically reduce the risk of tumor perforation and CRM infiltration and local recurrence rate...
March 2014: Cirugía Española
Deborah S Keller, Justin K Lawrence, Conor P Delaney
This video demonstrates a laparoscopic abdominal perineal resection for a fixed 4.8-cm mass involving the posterior and left rectal walls and left puborectalis, 2 cm from the anal verge (see Video, Supplemental Digital Content 1, We detail the steps of the procedure, all completed in lithotomy, including lateral-to-medial dissection; identification and protection of the left ureter and presacral nerves; division of the inferior mesenteric artery; medial-to-lateral dissection, with meeting the previous dissection plane; total mesorectal excision and pelvic dissection; perineal dissection and layered closure; and abdominal inspection and colostomy creation...
February 2014: Diseases of the Colon and Rectum
G Ramsay, C Parnaby, C Mackay, P Hanlon, S Ong, M Loudon
AIMS: Abdominoperineal excision of rectum (APE) for cancer has a higher rate of local recurrence with a poorer outcome than stage matched anterior resection. The cylindrical excision (ELAPE) has been advocated to reduce local recurrence. However, this operation has greater morbidity and requires more post operative care. We report our outcomes from a single centre using a levator sparing dissection. METHODS: All patients undergoing APE from January 2007-June 2011 were evaluated...
November 2013: European Journal of Surgical Oncology
Jia-gang Han, Zhen-jun Wang, Guang-hui Wei, Zhi-gang Gao, Yong Yang, Bing-qiang Yi, Hua-chong Ma, Bo Zhao, Bao-cheng Zhao, Hao Qu
OBJECTIVE: To evaluate the safety and efficacy of individual cylindrical abdominoperineal resection (CAPR) for locally advanced low rectal cancer. METHODS: From June 2011 to February 2012, 11 patients with locally advanced low rectal cancer underwent individual CAPR. There were 7 male and 4 female patients, aged from 32 to 74 years with a median of 64 years. Forty-seven patients underwent classic CAPR from January 2008 to February 2012. Preoperative and postoperative parameters such as clinical information of patients, tissue morphometry and complications were compared...
April 2013: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Sumeet Toshniwal, Marlon Perera, David Lloyd, Hung Nguyen
BACKGROUND: The abdominoperineal resection (APR) is the current accepted surgical technique for low rectal cancers. Negative circumferential surgical margins are an important prognostic indicator and are best obtained by producing a cylindrical specimen. The 'ideal' approach to produce such specimen is debated between a standard lithotomy position and turning the patient in the prone position in the later stages of the procedure. We aimed to assess results of perineal morbidity and oncological outcomes following the lithotomy approach at a single institution...
November 2013: ANZ Journal of Surgery
Pan Hua-Feng, Jiang Zhi-Wei, Wang Gang, Liu Xin-Xin, Liu Feng-Tao
BACKGROUND: Our novel approach is a hybrid between cylindrical abdominoperineal resection and single-incision laparoscopic surgery (SILS). We report the clinical application of this technique and present preliminary data that shows this approach to be an effective tool for resection of low rectal cancer. METHODS: Twenty patients with endoscopy-considered and biopsy-proven malignant lesions were required to undergo abdominal computed tomography examination for determining tumor stage...
December 2012: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
Malika Bennis, Emmanuel Tiret
Evidence-based medicine was first defined by Sackett as 'the conscientious, explicit and judicious use of the current best evidence in making decisions about the care of individual patients'. This requires good quality studies with a high level of proof. However, these studies are often lacking in colorectal surgery. Nevertheless, the topics on which there is general agreement will be discussed. There is now good evidence that the laparoscopic approach is at least equivalent in oncological terms to the conventional open approach in colonic surgery...
2012: Digestive Diseases
Zhen-jun Wang, Jia-gang Han
Cylindrical abdominoperineal resection (CAPR), also known as extralevator abdominoperineal excision (ELAPE), has been described as a method for improving the outcome of APR for advanced low rectal cancer, probably because of more pelvic dissection and less positive circumferential resection margin (CRM). Recently, there have been some hot issues associated with CAPR/ELAPE, such as pelvic floor reconstruction methods, prone or lithotomy positioning during pelvic procedure, postoperative chronic perineal pain, postoperative sexual and urinary nerves damage, etc...
October 2012: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Pan Chi, Zhi-Fen Chen, Hui-Ming Lin, Xing-Rong Lu, Ying Huang
BACKGROUND: The extralevator abdominoperineal resection (ELAPR) is a new surgical technique for patients with low advanced rectal cancer. This technique requires an extra excision of the levator muscles to avoid the surgical waist caused by the conventional abdominoperineal resection, with the patient's position changed to a prone jackknife position and using a myocutaneous flap to repair the pelvic defect. To simplify this operation, we applied a laparoscopic technique to perform controlled transabdominal transection of the levator muscles under direct visualization without a position change and pelvic floor reconstruction using human acellular dermal matrix (HADM)...
May 2013: Annals of Surgical Oncology
Jonathan A Barker, Alexander E Blackmore, Richard P Owen, Anthony Rate
PURPOSE: Prone cylindrical abdominoperineal resection (APR) leads to reduced circumferential resection margin (CRM) involvement but is associated with a large perineal deficit. A rectus abdominis myocutaneous (RAM) flap can reduce the morbidity associated with the perineal wound. This is often performed in coordination with a plastic surgeon. We reviewed the outcome of prone APR carried out by a single colorectal surgeon using RAM flap without the involvement of plastic surgeons in a district general hospital...
June 2013: International Journal of Colorectal Disease
Celeste Y Kang, Joseph C Carmichael, Jeffrey Friesen, Michael J Stamos, Steven Mills, Alessio Pigazzi
Extralevator abdominoperineal resection (E-APR) has been advocated as a superior procedure to achieve negative circumferential resection margins (CRMs) for sphincter-invading rectal cancers. An open total mesorectal excision is performed followed by perineal dissection with resection of the levators in the prone position. We describe a novel minimally invasive robotic approach carried out in the lithotomy position. Using the robotic arms to dissect the rectum and divide the levator fibers at their origin, the dissection is carried out in the ischiorectal space as distally as possible...
October 2012: American Surgeon
Jia Gang Han, Zhen Jun Wang, Guang Hui Wei, Zhi Gang Gao, Yong Yang, Bao Cheng Zhao
BACKGROUND: An alternative treatment for low rectal cancer is the cylindrical technique. We aim to compare the outcomes of patients undergoing conventional abdominoperineal resection (APR) versus cylindrical APR. METHODS: A prospective, randomized, open-label, parallel controlled trial was conducted between January 2008 and December 2010. Sixty-seven patients with T3-T4 low rectal cancer were identified during the study period (conventional n = 32, cylindrical n = 35)...
September 2012: American Journal of Surgery
A Krishna, M J F X Rickard, A Keshava, O F Dent, P H Chapuis
AIM: The study aimed to compare recent reports on standard and alternative methods of abdominoperineal excision for low rectal cancer regarding the rates of circumferential resection margin involvement and intra-operative bowel perforation. METHOD: Data on rates of margin involvement and perforation were obtained from eight recently published reports and also from a prospective registry of resections at Concord Hospital. Rates of these outcomes and their 95% confidence intervals were evaluated...
January 2013: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
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