D Kamali, A Sharpe, A Musbahi, Y Viswanath, A Reddy. James Cook University Hospital, Middlesbrough U.K.
Extra-levator abdominoperineal excision (ELAPE) has previously been demonstrated to reduce levels of circumferential margin involvement and local recurrence rates, with possible improved patient survival compared to standard abdominoperineal excision (SAPE). ELAPE is a more radical procedure than SAPE and little is known about its long-term effects on patients’ wellbeing. This study set out to determine the long-term quality of life (QOL) of patients having had ELAPE compared to those having had SAPE.
Patients who had undergone either SAPE or ELAPE for rectal cancer between January 2009 and December 2014 at a major surgical unit were recruited into the study. Patient demographics, peri-operative details and follow-up data were recorded and analysed. QOL was determined using the EORTC QLC-CR30 and QLC-CR29 questionnaires. Chi-squared, Fisher exact and Mann Whitney tests were used to compare data as appropriate. A P value of <0.05 was considered to be statistically significant.
45 patients (35 male; mean age 67.4 years; 24 ELAPE cases and 21 SAPE controls) were studied. One patient who underwent SAPE died within thirty days of surgery. There was no mortality in the ELAPE group. Circumferential resection margin (CRM) was positive in 2 patients (4.4%), both of whom underwent ELAPE. Both patients had CRM involvement on pre-operative imaging and had adjuvant treatment. Two patients (4.4%) had R1 resections, both of whom had undergone ELAPE for a perforated tumour and CRM involvement and iliac node involvement prior to adjuvant treatment respectively. One patient who had undergone ELAPE developed local recurrence. While total recurrence rate was greater in SAPE patients compared to ELAPE patients (24% versus 17% respectively) the difference was not statistically significant. There was no significant difference in global health score (76.0 versus 65.3) between patients undergoing ELAPE and those undergoing SAPE, respectively. Impotence was the most frequently reported problem encountered by both ELAPE (89.7) and SAPE (83.3) patients.
Although a more radical surgery, ELAPE did not demonstrate any significant impact on QOL compared to SAPE. There was no significant difference in long-term oncological outcome. Impotence remains a significant problem for all patients and they should be well informed of this risk prior to surgery.