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Commentary |

Extralevator Abdominoperineal Resection for Low Rectal Cancer:  New Direction or Miles Behind?

Des C. Winter, MD, FRCSI
Arch Surg. 2010;145(9):811-813. doi:10.1001/archsurg.2010.174.
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While the rate of sphincter-preserving surgery for rectal cancer has increased, approximately one-fifth of patients will still require abdominoperineal excision (APE). Poor outcomes in some series have lead to suggestions that the oncological result in these patients is worse than in those undergoing anterior resection.1 Is this because of distinct tumor biology compared with more proximal cancers? There is some evidence to show that tumors treated with APE are more locally advanced. However, with optimized surgery and avoidance of either margin positivity or intraoperative perforation, outcomes with APE should be similar to those following anterior resection.2 Is it then that poorer outcomes following APE are a reflection of inadequate surgery, an uncomfortable truth for the surgical community?

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Figure.

Anterior and posterior surfaces of specimens from abdominoperineal excisions with serial cross-sectional slices. A, Standard specimen with surgical waist. B-D, Cylindrical specimens. Cross-sectional slices of standard (E) and cylindrical (F) specimens. Reprinted with permission from the American Society of Clinical Oncology.

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