Early Post-Operative Perineal Wound Complications in Patients Undergoing Extra Levator Abdominoperineal Excision, A Retrospective Study at Department of Surgical Oncology

Objectives: Extra Levator Abdominoperineal Excision (ELAPE) is an emerging technique for the management of locally advanced distal rectal cancers. Current evidence suggests that this technique is associated with better oncological outcomes and hence survival. Extra levator abdominoperineal excision is associated with significant perineal complications both in short and long term. The objective of the current study is to emphasize on the early wound complications of the above-mentioned procedure. Study Design: It was a retrospective observational study with continent sampling. Place and Duration of Study: The study was conducted at department of Surgical Oncology Shaukat Khanum Memorial Cancer Hospital & Research Center Lahore, Pakistan. The study period was from 1st January 2014 to 31st December, 2019. Patients and Methods: A total of 84 patients were included in the study who underwent extra levator abdominoperineal excision (ELAPE). All patients undergoing extra levator abdominoperineal excision during the said period were included. Results: A total of 84 patients underwent Extra Levator Abdominoperineal Excision between January 2014 and December 2019. Wound infection was observed in 32 (38.09%) of the patients. Wound dehiscence was seen is five patients. Median day of detection of infection was day 10 (5-22). Median hospital stay was 7 (4-22) days. Conclusion: Extra Levator Abdominoperineal Excision is a procedure with significant perineal wound complication rate. The occurrence of perineal wound complications is multifactorial. Judicial use of the procedure is warranted

Current practice in abdominoperineal resection: an email survey of the membership of the Association of Coloproctology

INTRODUCTION This study aimed to gain insight into current preferences for type of surgical approach and patient positioning in abdominoperineal excision of the rectum (APER), to identify whether these factors affect self-reported oncological outcomes and complication rates, and to assess the opinions of members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) with regards to the benefit of a national training programme for APER surgery. METHODS Members of the ACPGBI were surveyed using a questionnaire designed to examine surgeon/departmental demographics, type of APER practised, audit of results and complications, opinions regarding extralevator APER (ELAPER) and opinions regarding the potential benefit of a national training programme. RESULTS According to the survey, 62% of surgeons perform perineal dissection in the supine position and 57% perform a standard APER technique. Surgeons who only practise colorectal surgery (p=0.002) and surgeons performing prone dissection (/xO.0001) are more likely to perform ELAPER. Three-quarters (76%) audit their results for perineal wound complication rates. Over 80% audit their oncological outcomes. The vast majority (94.6%) of those who perform ELAPER believe there is a benefit to this method while 59.6% of those who do not perform ELAPER still believe there is a benefit to ELAPER. Only 50% feel that there should be a national training programme. CONCLUSIONS There is a distinct discordance with regards to the APER technique. Among UK colorectal surgeons, although a significant proportion favours ELAPER, there remains a larger proportion still performing standard APER techniques.