International Journal of Colorectal Disease

, Volume 33, Issue 4, pp 375–381 | Cite as

Extralevator versus standard abdominoperineal excision in locally advanced rectal cancer: a retrospective study with long-term follow-up

  • Anu Carpelan
  • J. Karvonen
  • P. Varpe
  • A. Rantala
  • A. Kaljonen
  • J. Grönroos
  • H. Huhtinen
Original Article



To analyze the results of abdominoperineal excisions (APE) for locally advanced rectal cancer at our institution before and after the adoption of extralevator abdominoperineal excision (ELAPE) with a special reference to long-term survival.


A retrospective cohort study conducted in a tertiary referral center. All consecutive patients operated for locally advanced (TNM classification T3–4) rectal cancer with APE in 2004–2009 were compared to patients with similar tumors operated with ELAPE in 2009–2016.


Forty-two ELAPE and 27 APE patients were included. Circumferential resection margin (CRM) was less than 1 mm (R1-resection) in 10 (24%) of ELAPE patients and 11 (41%) of APE patients (p = 0.1358). Intraoperative perforation (IOP) occurred in 4 (10%) patients and 6 (22%) patients in ELAPE and APE groups, respectively (p = 0.1336). There were 3 (7%) local recurrences (LRs) in ELAPE group and 5 (19%) in APE (p = 0.2473). There were no statistical differences in adverse events, overall survival, or disease-free survival between ELAPE and APE groups.


We found a non-significant tendency to lower rates of IOP and positive CRM as well as lower rate of LR in the ELAPE group. Long-term survival and adverse events did not differ between the groups. ELAPE is beneficial for the surgeon in offering better vicinity to the perineal area and better work ergonomics. These technical aspects and the clinically very important tendency to lower rate of LR support the use of ELAPE technique in spite of the lack of survival benefit.


Abdominoperineal excision Adverse events Extralevator Local recurrence Rectal cancer Survival 



This study was supported by research grants from the TYKS Foundation, the Turunmaa Duodecim Society, and Turku University Hospital (EVO grant no. 13191).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Digestive Surgery and UrologyTurku University Hospital and University of TurkuTurkuFinland
  2. 2.Biostatistics, Department of Clinical MedicineUniversity of TurkuTurkuFinland

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