The LOREC APE registry: operative technique, oncological outcome and perineal wound healing after abdominoperineal excision.

Journal article

Aim

The 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.

Method

Surgeons wishing to participate received secure web-based access to the registry. Collected data included pre-operative staging, neo-adjuvant treatment, operative details, histopathology, early outcome and follow-up at 12 months.

Results

42 units entered 266 patients. Of these 172 (65%) underwent extralevator APE (ELAPE) and 94 non-ELAPE. On pre-operative staging 64% were mrT3/4 and 67% received neoadjuvant treatment. For ELAPE the perineal wound was closed primary with mesh in 55%, without mesh in 15% and with a flap in 21% of cases. For non-ELAPEs, 54% of wounds were closed primarily without mesh, 29% primarily with mesh and 5% by a flap. Wound breakdown occurred in 30% of ELAPE and 31% of non-ELAPE, but was more common after neo-adjuvant radiotherapy. Donor site complications occurred in 17% of flap cases. 11% of patients had perineal morbidity at 12 months. On histopathology, the resection margin was positive in 13% of ELAPE and in 4% of non-ELAPE.

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 rate of an involved resection margin was less than reported in many historical series but still remains high in the ELAPE group.

Authors: Jones, H; Moran, B; Crane, S; Hompes, R; Cunningham, C

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Wiley
• Journal: Colorectal Disease
• Volume: 19
• Issue: 2
• Pages: 172-180
• Publication date: 2016-06-01
• Acceptance date: 2016-04-28
• DOI: 10.1111/codi.13423
• EISSN: 1463-1318
• ISSN: 1462-8910
• Pmid: 27321172
• Language: English
• Keywords: APE; Rectal cancer; perineal wound healing