{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T11:54:23Z","timestamp":1792670063702,"version":"4.5.0"},"reference-count":36,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,2,3]],"date-time":"2017-02-03T00:00:00Z","timestamp":1486080000000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2017,2]]},"abstract":"Abstract<\/jats:title>\n \n Aim<\/jats:title>\n \n A randomized controlled trial was conducted to test the null hypothesis that there is no difference in circumferential resection margin (\n CRM<\/jats:styled-content>\n ) between extralevator abdominoperineal excision (\n ELAPE<\/jats:styled-content>\n ) and non\u2010\n ELAPE<\/jats:styled-content>\n for rectal cancer.\n <\/jats:p>\n <\/jats:sec>\n \n Method<\/jats:title>\n \n This was a multicentre, randomized controlled trial registered as\n NCT<\/jats:styled-content>\n 01702116. Patients with rectal cancer involving the external anal sphincter were randomized to\n ELAPE<\/jats:styled-content>\n or non\u2010\n ELAPE<\/jats:styled-content>\n following neoadjuvant chemoradiation. Randomization was performed according to Consolidated Standards of Reporting Trials (\n CONSORT<\/jats:styled-content>\n ) guidelines. The primary end\u2010point was\n CRM<\/jats:styled-content>\n (in mm), defined as the shortest distance between the tumour and the cut edge of the specimen. Pathologists and centralized pathology were blinded to the patients\u2019 study arm. Interrater reliability (\n IRR<\/jats:styled-content>\n ) was assessed using Kendall's coefficient. Intra\u2010operative perforation (\n IOP<\/jats:styled-content>\n ) was any rectal defect determined at pathology. Complications were classified using the Clavien\u2013Dindo classification. Participating surgeons were retrained and credentialed. A sample size calculation showed that 34 subjects would provide sufficient power to reject the null hypothesis.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Thirty\u2010four patients underwent the allocated intervention. Seventeen patients treated with\n ELAPE<\/jats:styled-content>\n were comparable with 17 patients treated with non\u2010\n ELAPE<\/jats:styled-content>\n regarding age, gender, body mass index (\n BMI<\/jats:styled-content>\n ), American Society of Anesthesiology (\n ASA<\/jats:styled-content>\n ) class and pre\u2010existing comorbidities.\n CRM<\/jats:styled-content>\n depth (7.14\u00a0\u00b1\u00a05.76\u00a0mm\n vs<\/jats:italic>\n 2.98\u00a0\u00b1\u00a03.28\u00a0mm,\n P\u00a0<\/jats:italic>\n =\n \u00a0<\/jats:italic>\n 0.016) and involvement rates (5.8%\n vs<\/jats:italic>\n 41.0%,\n P\u00a0<\/jats:italic>\n =\n \u00a0<\/jats:italic>\n 0.04) were significantly increased in patients treated with\n ELAPE<\/jats:styled-content>\n . The\n IRR<\/jats:styled-content>\n for\n CRM<\/jats:styled-content>\n was 0.78. There were no significant differences in\n IOP<\/jats:styled-content>\n (5.8%\n vs<\/jats:italic>\n 11.7%,\n P\u00a0<\/jats:italic>\n =\n \u00a0<\/jats:italic>\n 0.77) and complication rates (29%\n vs<\/jats:italic>\n 29%,\n P\u00a0<\/jats:italic>\n =\n \u00a0<\/jats:italic>\n 0.97).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n ELAPE<\/jats:styled-content>\n was associated with statistically improved\n CRM<\/jats:styled-content>\n with no difference in\n IOP<\/jats:styled-content>\n and complication rates compared with non\u2010\n ELAPE<\/jats:styled-content>\n for rectal cancer involving the external anal sphincter.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/codi.13436","type":"journal-article","created":{"date-parts":[[2016,7,1]],"date-time":"2016-07-01T22:42:43Z","timestamp":1467412963000},"page":"148-157","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Extralevator with\n vs<\/i>\n nonextralevator abdominoperineal excision for rectal cancer: the\n RELAP<\/scp>\n e randomized controlled\u00a0trial"],"prefix":"10.1111","volume":"19","author":[{"given":"F.","family":"Bianco","sequence":"first","affiliation":[{"name":"Division of Colorectal Surgery State University of New York Stony Brook New York USA"},{"name":"Department of Colorectal Surgery National Cancer Institute Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Romano","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery National Cancer Institute Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Tsarkov","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Sechenov First Moscow State Medical University Moscow Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Stanojevic","sequence":"additional","affiliation":[{"name":"Department of 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