{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T02:58:04Z","timestamp":1789181884814,"version":"build-2803163510"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":43,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"County Council of V\u00e4sterbotten, Sweden","award":["VLL-187711"],"award-info":[{"award-number":["VLL-187711"]}]},{"name":"County Council of V\u00e4sterbotten, Sweden","award":["VLL-226241"],"award-info":[{"award-number":["VLL-226241"]}]},{"DOI":"10.13039\/501100007687","name":"Swedish Society of Medicine","doi-asserted-by":"publisher","award":["SLS-97651"],"award-info":[{"award-number":["SLS-97651"]}],"id":[{"id":"10.13039\/501100007687","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007687","name":"Swedish Society of Medicine","doi-asserted-by":"publisher","award":["SLS-176651"],"award-info":[{"award-number":["SLS-176651"]}],"id":[{"id":"10.13039\/501100007687","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Swedish Society for Colon and Rectal Surgeons"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Optimal reconstruction of the perineal defect after extended abdominoperineal excision remains uncertain, and randomized comparisons between biological mesh and myocutaneous flaps are lacking. This trial assessed whether an acellular porcine collagen implant (APCI) is non-inferior to a gluteus maximus myocutaneous flap (GMF) for pelvic floor reconstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>NEAPE was a multicentre, randomized, non-inferiority trial conducted in eight Nordic referral centres. Adults undergoing extended abdominoperineal excision for rectal cancer were randomized to reconstruction with an APCI or unilateral GMF. The primary outcome was the proportion of patients underperforming in the timed-stands test at 6 months, defined relative to age- and sex-matched reference values. The non-inferiority margin was \u221210%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eighty-three patients were included in the modified intention-to-treat population (mean(standard deviation) age 68(10) years; 31% female). At 6 months, 71% of patients (25 of 35) in the implant group and 60% of patients (20 of 33) in the flap group underperformed. The risk difference was \u221211% (one-sided 95% confidence interval \u221230% to \u221e), and non-inferiority was not demonstrated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The APCI did not demonstrate non-inferiority compared with the GMF. The direction of the effect favoured the flap, with results compatible with worse functional outcomes in the implant group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration number<\/jats:title>\n                    <jats:p>ClinicalTrials.gov NCT01347697.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrag079","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T11:34:09Z","timestamp":1779190449000},"source":"Crossref","is-referenced-by-count":1,"title":["Collagen implant\n                    <i>versus<\/i>\n                    gluteus maximus flap for perineal closure after extended abdominoperineal excision: NEAPE randomized clinical trial"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0974-6373","authenticated-orcid":false,"given":"Martin","family":"Ruteg\u00e5rd","sequence":"first","affiliation":[{"name":"Department of Diagnostics and Intervention, Surgery, Ume\u00e5 University , Ume\u00e5 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"Svensson","sequence":"additional","affiliation":[{"name":"Department of Diagnostics and Intervention, Surgery, Ume\u00e5 University , Ume\u00e5 ,","place":["Sweden"]},{"name":"Department of Statistics, Ume\u00e5 School of Business, Economics and Statistics, Ume\u00e5 University , Ume\u00e5 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rgen","family":"Ruteg\u00e5rd","sequence":"additional","affiliation":[{"name":"Department of Diagnostics and Intervention, Surgery, Ume\u00e5 University , Ume\u00e5 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tero","family":"Rautio","sequence":"additional","affiliation":[{"name":"Oulu University Hospital, Medical Research Centre Oulu , Oulu ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per J","family":"Nilsson","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olle","family":"Sj\u00f6str\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Diagnostics and Intervention, Surgery, Ume\u00e5 University , Ume\u00e5 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Louise","family":"Lydrup","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sk\u00e5ne University Hospital, Malm\u00f6, Lund University , Lund ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoffer","family":"Odensten","sequence":"additional","affiliation":[{"name":"Department of Diagnostics and Intervention, Surgery, Ume\u00e5 University , Ume\u00e5 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"S\u00f6derstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Diagnostics and Intervention, Surgery, Ume\u00e5 University , Ume\u00e5 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Dahlberg","sequence":"additional","affiliation":[{"name":"Department of Diagnostics and Intervention, Surgery, Ume\u00e5 University , Ume\u00e5 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markku M","family":"Haapam\u00e4ki","sequence":"additional","affiliation":[{"name":"Department of Diagnostics and Intervention, Surgery, Ume\u00e5 University , Ume\u00e5 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"2026062414312888300_zrag079-B1","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.1016\/S0140-6736(00)99076-7","article-title":"A method of performing abdominoperineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon","volume":"172","author":"Miles","year":"1908","journal-title":"Lancet"},{"key":"2026062414312888300_zrag079-B2","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1111\/j.1463-1318.2008.01520.x","article-title":"Local recurrence after abdomino-perineal resection","volume":"11","author":"Davies","year":"2009","journal-title":"Colorectal Dis"},{"key":"2026062414312888300_zrag079-B3","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1007\/BF02055425","article-title":"Abdominoperineal excision of the rectum\u2014an endangered operation. 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