• N P West, C Anderin, K J E Smith, T Holm, P Quirke, and European Extralevator Abdominoperineal Excision Study Group.
• Pathology and Tumour Biology, Leeds Institute of Molecular Medicine, University of Leeds, UK. n.p.west@leeds.ac.uk
• Br J Surg. 2010 Apr 1; 97 (4): 588599588-99.

BackgroundAbdominoperineal excision (APE) for low rectal cancer is associated with higher rates of circumferential resection margin (CRM) involvement and intraoperative perforation (IOPs) than anterior resection for higher tumours. This multicentre observational study was designed to confirm that extralevator APE can improve outcomes and investigated the morbidity associated with such extensive surgery.MethodsSome 176 extralevator APE procedures from 11 European colorectal surgeons were compared with 124 standard excisions from one UK centre. Clinical and pathological data were collected along with specimen photographs. Tissue morphometry was performed on the distal ten slices of the excision.ResultsExtralevator APE removed more tissue from outside the smooth muscle layer per slice (median area 2120 versus 1259 mm(2); P < 0.001) leading to a reduction in CRM involvement (from 49.6 to 20.3 per cent; P < 0.001) and IOP (from 28.2 to 8.2 per cent; P < 0.001) compared with standard surgery. However, extralevator surgery was associated with an increase in perineal wound complications (from 20 to 38.0 per cent; P = 0.019).ConclusionExtralevator APE is associated with less CRM involvement and IOP than standard surgery.Copyright (c) 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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