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The LOREC APE registry: operative technique, oncological outcome and perineal wound healing after abdominoperineal excision.
- Source :
-
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Colorectal Dis] 2017 Feb; Vol. 19 (2), pp. 172-180. - Publication Year :
- 2017
-
Abstract
- Aim: The Low Rectal Cancer Development programme (LOREC) perineal wound healing registry was developed to record data on abdominoperineal excision (APE) for rectal cancer in colorectal units in England between 2012 and 2014, to understand current practice in operative technique and results.<br />Method: Surgeons wishing to participate received secure Web-based access to the registry. Data were collected on preoperative staging, neoadjuvant treatment, operative details, histopathology, early outcome and follow up at 12 months.<br />Results: Forty-two units entered 266 patients. Of these, 172 (65%) patients underwent extralevator APE (ELAPE) and 94 had non-ELAPE procedures. On preoperative staging, 64% were mrT3/4, and 67% received neoadjuvant treatment. For the ELAPE group the perineal wound was closed primarily with mesh in 55% of patients, without mesh in 15% and with a flap in 21%. For non-ELAPE procedures, 54% of wounds were closed primarily without mesh, 29% primarily with mesh and 5% by a flap. Wound breakdown occurred in 30% and 31% of patients in the ELAPE and non-ELAPE groups, respectively, and was more common after neoadjuvant radiotherapy. Donor-site complications occurred in 17% of patients treated with a flap. Perineal morbidity was recorded in 11% of patients at 12 months. On histopathology, the resection margin was positive in 13% of patients in the ELAPE group and in 4% of patients in the non-ELAPE group.<br />Conclusion: The LOREC registry provides a picture of current APE practice in England. ELAPE was used in two-thirds of patients but does not appear to confer any additional morbidity. Primary closure with mesh appeared as effective as flap reconstruction. The prevalence of an involved resection margin was lower than reported in many historical series but still remains high in the ELAPE group.<br /> (Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.)
- Subjects :
- Adult
Aged
Aged, 80 and over
England epidemiology
Female
Humans
Male
Middle Aged
Neoadjuvant Therapy
Neoplasm Staging
Radiotherapy
Rectal Neoplasms pathology
Surgical Flaps
Surgical Mesh
Wound Healing
Abdomen surgery
Digestive System Surgical Procedures methods
Perineum surgery
Postoperative Complications epidemiology
Rectal Neoplasms surgery
Rectum surgery
Registries
Wound Closure Techniques
Subjects
Details
- Language :
- English
- ISSN :
- 1463-1318
- Volume :
- 19
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
- Publication Type :
- Academic Journal
- Accession number :
- 27321172
- Full Text :
- https://doi.org/10.1111/codi.13423