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Title: Abdominoperineal excision in Australasia: clinical outcomes, predictive factors and recent trends of nonrestorative rectal cancer surgery.
Epworth Authors: Smith, Nicholas
Waters, Peadar
Peacock, Oliver
Kong, Joseph
Lynch, Craig
Heriot, Alexander
Warrier, Satish
Keywords: Adomininoperineal Resection
Circumferential Resection Margin
Predictive Factors
Restorative Resection
Binational Colorectal Cancer Audit
Colorectal Cancer
Epworth Cancer Services Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Nov-2020
Publisher: Wiley
Citation: Nov 22(11) 1614-1625
Abstract: Aim: The decision to perform an abdominoperineal excision (APR) rather than restorative bowel resection relies on a number of clinical factors. There remains great variability in APR rates internationally. The aim of this study was to demonstrate trends of APR surgery in low rectal cancer (< 6 cm from the anal verge) in Australasia and identify predictors of nonrestoration. Method: This study reviewed a prospectively maintained colorectal registry - the Binational Colorectal Cancer Audit (BCCA) - from general/colorectal surgical units across Australia and New Zealand. Data were analysed to determine factors predictive of nonrestorative resection. Patients were analysed based on the presence (control) or absence (comparison) of a primary anastomosis. Results: Of 3628 patients with rectal cancer, 2096 were diagnosed with low rectal cancer between 2007 and 2017. The incidence of APR remained constant over the study period, with 58% of all resections of low rectal cancer being APR. The majority of resections were performed by consultants in urban hospitals (86% vs 14%). Tumours ≤ 3 cm from the anal verge, T4, M1 disease and neoadjuvant therapy were the greatest predictors of APR (P < 0.001). A significantly increased rate of restorative surgery was observed in public hospital settings (59% vs 41%, P < 0.05). The rate of positive circumferential resection margin (CRM) was 7.95%, with significantly increased rates in patients undergoing APR (12.2% vs 6.2%, P < 0.001). CRM positivity was increased in open approaches, T4, N2 and M1 staged disease and in an emergency/urgent setting (P < 0.001 and P < 0.045, respectively). Significantly increased wound and pulmonary complications were observed in the APR cohort (P < 0.01). Conclusion: The rates of APR in Australia and New Zealand remain high but are comparable to international figures, with one-third of rectal cancers being treated by APR. The main determinants of APR are tumour height, T stage and neoadjuvant therapy requirement. CRM positivity was higher in APR patients.
DOI: 10.1111/codi.15263
PubMed URL:
Journal Title: Colorectal Disease
Type: Journal Article
Affiliated Organisations: Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Type of Clinical Study or Trial: Comparative Study
Appears in Collections:General Surgery and Gastroenterology

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