The quality of lymph node harvests in extralevator abdominoperineal excisions
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Authors
Liu, Ben
Farquharson, Ja'Quay
Issue Date
2020-10-16
Journal
Type
Observational Study
Retrospective Study
Peer-Reviewed Publication
Retrospective Study
Peer-Reviewed Publication
Keywords
Abdominoperineal excisions
Lymph nodes
Colorectal cancer
Rectal cancer
Prognosis
Extralevator abdominoperineal excisions
ELAPE
Harvesting
Rectal neoplasms
Surgical procedures
Proctectomy
Lymph node excision
Lymph nodes
Colorectal cancer
Rectal cancer
Prognosis
Extralevator abdominoperineal excisions
ELAPE
Harvesting
Rectal neoplasms
Surgical procedures
Proctectomy
Lymph node excision
Journal Title
BMC Surgery
Volume
20
Issue
1
Begin page
241
End page
Abstract
Background: Lymph node (LN) harvest in colorectal cancer resections is a well-recognised prognostic factor for disease staging and determining survival, particularly for node-negative (N0) diseases. Extralevator abdominoperineal excisions (ELAPE) aim to prevent "waisting" that occurs during conventional abdominoperineal resections (APR) for low rectal cancers, and reducing circumferential resection margin (CRM) infiltration rate. Our study investigates whether ELAPE may also improve the quality of LN harvests, addressing gaps in the literature.
Methods: This retrospective observational study reviewed 2 sets of 30 consecutive APRs before and after the adoption of ELAPE in our unit. The primary outcomes are the total LN counts and rates of meeting the standard of 12-minimum, particularly for those with node-negative disease. The secondary outcomes are the CRM involvement rates. Baseline characteristics including age, sex, laparoscopic or open surgery and the use of neoadjuvant chemoradiotherapy were accounted for in our analyses.
Results: Median LN counts were slightly higher in the ELAPE group (16.5 vs. 15). Specimens failing the minimum 12-LN requirements were almost significantly fewer in the ELAPE group (OR 0.456, P = 0.085). Among node-negative rectal cancers, significantly fewer resections failed the 12-LN standard in the ELAPE group than APR group (OR 0.211, P = 0.044). ELAPE led to a near-significant decrease in CRM involvement (OR 0.365, P = 0.088). These improvements were persistently observed after taking into account baselines and potential confounders in regression analyses.
Conclusion: ELAPE provides higher quality of LN harvests that meet the 12-minimal requirements than conventional APR, particularly in node-negative rectal cancers. The superiority is independent of potential confounding factors, and may implicate better clinical outcomes.
Citation
Liu B, Farquharson J. The quality of lymph node harvests in extralevator abdominoperineal excisions. BMC Surg. 2020 Oct 16;20(1):241. doi: 10.1186/s12893-020-00898-2. PMID: 33066759; PMCID: PMC7565360.