• Annals of surgery · Jun 2014

    Multicenter Study

    Differences in circumferential resection margin involvement after abdominoperineal excision and low anterior resection no longer significant.

    • Nicoline van Leersum, Ingrid Martijnse, Marcel den Dulk, Nikki Kolfschoten, Saskia Le Cessie, Cornelius van de Velde, Rob Tollenaar, Michel Wouters, and Harm J Rutten.
    • *Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands †Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands ‡Departments of Clinical Epidemiology and Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands §Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands ¶Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
    • Ann. Surg.. 2014 Jun 1;259(6):1150-5.

    ObjectiveThe aim of this study was to evaluate whether the abdominoperineal excision (APE) is associated with an increased risk of circumferential resection margin (CRM) involvement after rectal cancer surgery in comparison with low anterior resection (LAR).BackgroundThe oncologic inferiority of the APE technique in comparison with LAR has been widely reported in literature. However, because of large evolvement in rectal cancer care, outcomes after APE may have improved since then.MethodsThe population-based dataset of the Dutch Surgical Colorectal Audit was used selecting 5017 patients with primary rectal cancer undergoing surgery in 2010 to 2011. Propensity scores were calculated for the likelihood of performing an APE given relevant patient and tumor characteristics, and used in the multivariate analysis of CRM involvement.ResultsThe APE was associated with a slight, nonsignificant, increased risk of CRM involvement [odds ratio (OR) = 1.33; confidence interval (CI) = 0.93-1.90]. Absolute percentages of CRM involvement were 8% and 12% after LAR and APE, respectively.In the subgroup analysis, advanced rectal tumors (cT3-4) were associated to a higher risk of CRM involvement after APE (OR = 1.61; CI = 1.05-1.90), whereas smaller tumors (cT1-2) were not (OR = 0.62; CI = 0.27-1.40).ConclusionsThe results suggest that on a national level the APE procedure itself is not a strong predictor anymore for CRM involvement after rectal cancer surgery. However, in advanced tumors, results after APE are inferior to LAR.

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