The LOREC APE registry: operative technique, oncological outcome and perineal wound healing after abdominoperineal excision

• Published in: Colorectal disease Vol. 19; no. 2; pp. 172 - 180
• Main Authors: Jones, H., Moran, B., Crane, S., Hompes, R., Cunningham, C.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.02.2017
• Subjects: Abdomen - surgery; Adult; Aged; Aged, 80 and over; APE; Cancer; Complications; Digestive System Surgical Procedures - methods; England - epidemiology; Female; Histopathology; Humans; Male; Medical personnel; Middle Aged; Morbidity; Neoadjuvant Therapy; Neoplasm Staging; perineal wound healing; Perineum - surgery; Postoperative Complications - epidemiology; Radiation therapy; Radiotherapy; Rectal cancer; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Rectum; Rectum - surgery; Registries; Surgical Flaps; Surgical Mesh; Training; Wound Closure Techniques; Wound Healing; United Kingdom > UK; England; Rectal cancer; APE; perineal wound healing
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.13423

Aim The Low Rectal Cancer Development programme (LOREC) perineal wound healing registry was developed to record data on abdominoperineal excision (APE) for rectal cancer in colorectal units in England between 2012 and 2014, to understand current practice in operative technique and results. Method Surgeons wishing to participate received secure Web‐based access to the registry. Data were collected on preoperative staging, neoadjuvant treatment, operative details, histopathology, early outcome and follow up at 12 months. Results Forty‐two units entered 266 patients. Of these, 172 (65%) patients underwent extralevator APE (ELAPE) and 94 had non‐ELAPE procedures. On preoperative staging, 64% were mrT3/4, and 67% received neoadjuvant treatment. For the ELAPE group the perineal wound was closed primarily with mesh in 55% of patients, without mesh in 15% and with a flap in 21%. For non‐ELAPE procedures, 54% of wounds were closed primarily without mesh, 29% primarily with mesh and 5% by a flap. Wound breakdown occurred in 30% and 31% of patients in the ELAPE and non‐ELAPE groups, respectively, and was more common after neoadjuvant radiotherapy. Donor‐site complications occurred in 17% of patients treated with a flap. Perineal morbidity was recorded in 11% of patients at 12 months. On histopathology, the resection margin was positive in 13% of patients in the ELAPE group and in 4% of patients in the non‐ELAPE group. Conclusion The LOREC registry provides a picture of current APE practice in England. ELAPE was used in two‐thirds of patients but does not appear to confer any additional morbidity. Primary closure with mesh appeared as effective as flap reconstruction. The prevalence of an involved resection margin was lower than reported in many historical series but still remains high in the ELAPE group.