{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T13:30:34Z","timestamp":1769607034548,"version":"3.49.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2014,5,12]],"date-time":"2014-05-12T00:00:00Z","timestamp":1399852800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,5,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Abdominal perineal excision (APE) was originally described with levator ani removal for rectal cancer. An even wider, more aggressive extralevator resection for APE has been proposed. Although some surgeons are performing a very wide \u2018extralevator APE (ELAPE)\u2019, there are few data to recommend it routinely. This multicentre study aimed to compare outcomes of APE and ELAPE.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A multicentre propensity case-matched analysis comparing two surgical approaches (APE and ELAPE) was performed. All patients who underwent abdominoperineal resection of a rectal tumour were considered for the analysis. Tumour height was defined by magnetic resonance imaging measurement and patients with stage II\u2013III tumours had neoadjuvant radiochemotherapy. Involvement of the circumferential resection margin (CRM) and intraoperative tumour perforation were the main outcome measures. A logistic regression model was used to study the relationship between the surgical approaches and outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>From January 2008 to March 2013 a total of 1909 consecutive patients underwent APE or ELAPE, of whom 914 matched patients (457 in each group) formed the cohort for analysis. Intraoperative tumour perforation occurred in 7\u00b79 and 7\u00b77 per cent of patients during APE and ELAPE respectively (P = 0\u00b7902), and there was CRM involvement in 13\u00b71 and 13\u00b76 per cent (P = 0\u00b7846). There were no differences between APE and ELAPE in terms of postoperative complication rates (52\u00b73 versus 48\u00b71 per cent; P = 0\u00b7209), need for reoperation (7\u00b77 versus 7\u00b70 per cent; P = 0\u00b7703), perineal wound problems (26\u00b70 versus 21\u00b79 per cent; P = 0\u00b7141), mortality rate (2\u00b70 versus 2\u00b70 per cent; P = 1\u00b7000) and local recurrence rate at 2 years (2\u00b77 versus 5\u00b76 per cent; P = 0\u00b7664).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>ELAPE does not improve rates of CRM involvement, intraoperative tumour perforation, local recurrence or mortality.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/bjs.9522","type":"journal-article","created":{"date-parts":[[2014,5,12]],"date-time":"2014-05-12T10:33:59Z","timestamp":1399890839000},"page":"874-882","source":"Crossref","is-referenced-by-count":69,"title":["Multicentre 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