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Early experience with laparoscopic extralevator abdominoperineal excision within an enhanced recovery setting: analysis of short-term outcomes and quality of life

Early experience with laparoscopic extralevator abdominoperineal excision within an enhanced recovery setting: analysis of short-term outcomes and quality of life
Early experience with laparoscopic extralevator abdominoperineal excision within an enhanced recovery setting: analysis of short-term outcomes and quality of life
Introduction: conventional abdominoperineal excision for low rectal cancer has a higher local recurrence and reduced survival compared to anterior resection. An extralevator abdominoperineal excision (ELAPE) may improve outcome through removal of increased tissue in the distal rectum. Experience with ELAPE is limited and no studies have reported on quality of life (QOL) following this procedure. We describe a minimally invasive approach to ELAPE within an enhanced recovery programme, and present short-term results and QOL analyses.

Methods: all laparoscopic ELAPEs were included in a prospective database. Demographics, intra-operative and post-operative outcomes were evaluated. Postoperative QOL was assessed using the European Organisation for Research and Treatment of Cancer (EORTC) questionnaires QLQ-C30 and QLQ-CR29.

Results: thirteen laparoscopic ELAPEs were performed over a two-year period. All were enrolled in an enhanced recovery programme. The median age was 76. The median tumour height was 20 mm (range: 0-50 mm) from the dentate line and all patients received neoadjuvant treatment. The median duration of surgery was 300 minutes (range: 120-488 minutes), the mean blood loss was 150 ml and one procedure was converted to open surgery. There was no circumferential resection margin involvement or tumour perforation. The median duration of use of intravenous fluid, patient controlled analgesia and urinary catheterisation was 2, 2 and 2.5 days respectively and the median length of hospital stay was 7.5 days. Two patients developed perineal wound dehiscence. QOL analysis revealed high global health status (90.8), physical (91.3), emotional (98.3) and social functioning (100) scores, which compared favourably with EORTC reference values and published QOL scores following conventional abdominoperineal excision.

Conclusions: laparoscopic ELAPE within an enhanced recovery setting is a feasible and safe approach with acceptable short-term outcomes and post-operative quality of life
0035-8843
451-459
Vaughan-Shaw, P.G.
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King, A.T.
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Cheung, T.
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Beck, N.E.
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Knight, J.S.
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Nichols, P.H.
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Nugent, K.P.
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Pilkington, S.A.
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Smallwood, J.A.
46f8b12a-6df1-41fa-a2d2-220789b51828
Mirnezami, A.H.
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Vaughan-Shaw, P.G.
6dbf16eb-1225-46b6-89f2-cc7dd3aa4106
King, A.T.
4b9a9fda-db61-4a5f-9258-1997446a8bd5
Cheung, T.
a54dae69-47bc-40a1-8de8-81257ad4b631
Beck, N.E.
596183d1-9caa-47a5-92e4-b0e7057c880f
Knight, J.S.
43d732fc-8e92-4698-87ea-94248b7e6195
Nichols, P.H.
f583bcf0-5b3e-44af-9f4c-db1577009c4c
Nugent, K.P.
79fcb89d-6ff2-47b8-ac2c-2afb24954456
Pilkington, S.A.
1a2b595a-1e10-4cde-b477-fa63227859aa
Smallwood, J.A.
46f8b12a-6df1-41fa-a2d2-220789b51828
Mirnezami, A.H.
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Vaughan-Shaw, P.G., King, A.T., Cheung, T., Beck, N.E., Knight, J.S., Nichols, P.H., Nugent, K.P., Pilkington, S.A., Smallwood, J.A. and Mirnezami, A.H. (2011) Early experience with laparoscopic extralevator abdominoperineal excision within an enhanced recovery setting: analysis of short-term outcomes and quality of life. Annals of The Royal College of Surgeons of England, 93 (6), 451-459. (doi:10.1308/003588411X588621). (PMID:21929915)

Record type: Article

Abstract

Introduction: conventional abdominoperineal excision for low rectal cancer has a higher local recurrence and reduced survival compared to anterior resection. An extralevator abdominoperineal excision (ELAPE) may improve outcome through removal of increased tissue in the distal rectum. Experience with ELAPE is limited and no studies have reported on quality of life (QOL) following this procedure. We describe a minimally invasive approach to ELAPE within an enhanced recovery programme, and present short-term results and QOL analyses.

Methods: all laparoscopic ELAPEs were included in a prospective database. Demographics, intra-operative and post-operative outcomes were evaluated. Postoperative QOL was assessed using the European Organisation for Research and Treatment of Cancer (EORTC) questionnaires QLQ-C30 and QLQ-CR29.

Results: thirteen laparoscopic ELAPEs were performed over a two-year period. All were enrolled in an enhanced recovery programme. The median age was 76. The median tumour height was 20 mm (range: 0-50 mm) from the dentate line and all patients received neoadjuvant treatment. The median duration of surgery was 300 minutes (range: 120-488 minutes), the mean blood loss was 150 ml and one procedure was converted to open surgery. There was no circumferential resection margin involvement or tumour perforation. The median duration of use of intravenous fluid, patient controlled analgesia and urinary catheterisation was 2, 2 and 2.5 days respectively and the median length of hospital stay was 7.5 days. Two patients developed perineal wound dehiscence. QOL analysis revealed high global health status (90.8), physical (91.3), emotional (98.3) and social functioning (100) scores, which compared favourably with EORTC reference values and published QOL scores following conventional abdominoperineal excision.

Conclusions: laparoscopic ELAPE within an enhanced recovery setting is a feasible and safe approach with acceptable short-term outcomes and post-operative quality of life

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Published date: September 2011
Organisations: Cancer Sciences

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Local EPrints ID: 202961
URI: http://eprints.soton.ac.uk/id/eprint/202961
ISSN: 0035-8843
PURE UUID: af83c9f5-de34-4f46-ad1b-26e7f0e759e0

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Date deposited: 10 Nov 2011 11:50
Last modified: 14 Mar 2024 04:26

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Contributors

Author: P.G. Vaughan-Shaw
Author: A.T. King
Author: T. Cheung
Author: N.E. Beck
Author: J.S. Knight
Author: P.H. Nichols
Author: K.P. Nugent
Author: S.A. Pilkington
Author: J.A. Smallwood
Author: A.H. Mirnezami

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