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Will the Extra Levator Approach for Low Rectal Cancer Become the New Gold Standard?

Pitfalls of a New Technique from the Anatomical Perspective

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Multidisciplinary Management of Rectal Cancer

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Abstract

Total mesorectal excision (TME) involves radical en bloc excision of the rectum and mesorectum with an intact mesorectal fascia [1]. The object of TME is to achieve a tumour-free circumferential resection margin (CRM) to reduce the risk of local recurrent disease [2, 3]. Worldwide, low rectal cancer is a complex and challenging disease. Patients, in whom the bowel continuity cannot be restored because of a very low-lying rectal tumour or tumour invasion in the anal sphincter complex, are classically treated with an abdominoperineal excision (APE). This operation is associated with higher rates of tumour involvement of the CRM and intraoperative tumour perforations, resulting in a poorer oncological outcome when compared with a (low) anterior resection for more superiorly located rectal tumours [4, 5]. Due to the natural tapering of the mesorectum, the specimen is at great risk to distal coning, which often leads to a nonradical resection. One of the most difficult steps in APE is dissection of the perineal body.

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Authors and Affiliations

  1. Department of Radiation Oncology, Largo A. Gemelli 8 00168, Università Cattolica S Cuore, Rome, Italy

    A. C. Kraima, M. C. DeRuiter, C. J. H. van de Velde & H. J. Rutten

  2. Pathology and Tumour Biology, Level 4 Wellcome Trust Brenner Building, St James University Hospital, Leeds, UK

    P. Quirke

Authors
  1. A. C. Kraima
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  2. P. Quirke
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  3. M. C. DeRuiter
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  4. C. J. H. van de Velde
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  5. H. J. Rutten
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Corresponding author

Correspondence to P. Quirke .

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Editors and Affiliations

  1. Dept. of Radiation Oncology, Università Cattolica S Cuore, Rome, Italy

    Vincenzo Valentini

  2. Head, Div. Clinical Oncology Research, University Clinic Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle, Sachsen-Anhalt, Germany

    Hans-Joachim Schmoll

  3. Department of Surgery, Leiden Univ Med Ctr, Leiden, The Netherlands

    Cornelis J. H. van de Velde

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Kraima, A.C., Quirke, P., DeRuiter, M.C., van de Velde, C.J.H., Rutten, H.J. (2018). Will the Extra Levator Approach for Low Rectal Cancer Become the New Gold Standard?. In: Valentini, V., Schmoll, HJ., van de Velde, C. (eds) Multidisciplinary Management of Rectal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-43217-5_49

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  • DOI: https://doi.org/10.1007/978-3-319-43217-5_49

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43215-1

  • Online ISBN: 978-3-319-43217-5

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