Similar long-term overall and disease-free survival after conventional and extralevator abdominoperineal excision: a nationwide study

TY - JOUR

T1 - Similar long-term overall and disease-free survival after conventional and extralevator abdominoperineal excision

T2 - a nationwide study

AU - Klein, Mads

AU - Colov, Emilie Palmgren

AU - Gögenur, Ismail

PY - 2016/7/1

Y1 - 2016/7/1

N2 - PURPOSE: The purpose of the present study was to assess, compare, and identify factors of importance for long-term overall (OS) and disease-free (DFS) survival after conventional (cAPE) and extralevator abdominoperineal excision (ELAPE) on a nationwide basis.METHODS: This was a database study based on data from a nationwide colorectal cancer database. Patients undergoing surgery for rectal cancer in the period January 1, 2009 to August 31, 2012 were examined. Factors of importance for disease-free and overall survival were identified by multivariate Cox regressions.RESULTS: Five hundred patients were included in the final population. Two hundred seventy-six were operated by ELAPE and 224 by APE. Disease-free and overall survival did not differ between groups (4-year DFS 67 and 66 % after cAPE and ELAPE, respectively, (log-rank p = 0.82); 4-year OS 74 and 77 % after cAPE and ELAPE, respectively, (log-rank p = 0.59)). In Cox regression, the type of procedure did not affect DFS or OS. Factors of importance for DFS included increasing age, ypN-positive disease and neoadjuvant chemoradiation therapy. Factors of importance for OS included increasing age, circumferential resection margin (CRM) positivity, fixation of the tumor, blood transfusion, and increasing American Society of Anesthesiologists (ASA) score.CONCLUSIONS: In this nationwide study, we did not find any differences in DFS or OS after extralevator versus conventional abdominal perineal excision, and the type of procedure did not affect survival after adjusted analyses.

AB - PURPOSE: The purpose of the present study was to assess, compare, and identify factors of importance for long-term overall (OS) and disease-free (DFS) survival after conventional (cAPE) and extralevator abdominoperineal excision (ELAPE) on a nationwide basis.METHODS: This was a database study based on data from a nationwide colorectal cancer database. Patients undergoing surgery for rectal cancer in the period January 1, 2009 to August 31, 2012 were examined. Factors of importance for disease-free and overall survival were identified by multivariate Cox regressions.RESULTS: Five hundred patients were included in the final population. Two hundred seventy-six were operated by ELAPE and 224 by APE. Disease-free and overall survival did not differ between groups (4-year DFS 67 and 66 % after cAPE and ELAPE, respectively, (log-rank p = 0.82); 4-year OS 74 and 77 % after cAPE and ELAPE, respectively, (log-rank p = 0.59)). In Cox regression, the type of procedure did not affect DFS or OS. Factors of importance for DFS included increasing age, ypN-positive disease and neoadjuvant chemoradiation therapy. Factors of importance for OS included increasing age, circumferential resection margin (CRM) positivity, fixation of the tumor, blood transfusion, and increasing American Society of Anesthesiologists (ASA) score.CONCLUSIONS: In this nationwide study, we did not find any differences in DFS or OS after extralevator versus conventional abdominal perineal excision, and the type of procedure did not affect survival after adjusted analyses.

KW - Abdomen

KW - Aged

KW - Demography

KW - Digestive System Surgical Procedures

KW - Disease-Free Survival

KW - Female

KW - Humans

KW - Kaplan-Meier Estimate

KW - Male

KW - Middle Aged

KW - Muscles

KW - Perineum

KW - Proportional Hazards Models

KW - Time Factors

KW - Journal Article

U2 - 10.1007/s00384-016-2596-4

DO - 10.1007/s00384-016-2596-4

M3 - Journal article

C2 - 27129851

SN - 0179-1958

VL - 31

SP - 1341

EP - 1347

JO - International Journal of Colorectal Disease

JF - International Journal of Colorectal Disease

IS - 7

ER -