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Abdominoperineal excision in Australasia: clinical outcomes, predictive factors and recent trends of nonrestorative rectal cancer surgery
Author(s) -
Smith N.,
Waters P. S.,
Peacock O.,
Kong J. C.,
Lynch A. C.,
McCormick J. J.,
Heriot A.,
Warrier S. K.
Publication year - 2020
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.15263
Subject(s) - medicine , abdominoperineal resection , colorectal cancer , incidence (geometry) , anal verge , surgery , anastomosis , colorectal surgery , cancer , cancer registry , resection margin , resection , abdominal surgery , physics , optics
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.

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