Perineal Wound Outcomes after Extralevator Abdominoperineal Excision for Rectal Adenocarcinoma- A Tertiary Care Centre Experience

Extralevator Abdominoperineal excision (ELAPE) for low rectal cancer results in a large perineal defect, often requiring reconstruction by a biological or absorbable mesh or a flap as compared to conventional Abdominoperineal excision (CAPE). Although there are indications for oncological superiority with ELAPE, the incidence of wound-related complications is postulated to be higher when compared to CAPE due to the removal of more amount of tissue around the anorectum. On the other hand, the incidence of inadvertent rectal tube perforation during dissection is lesser in ELAPE and hence perineal wound breakdown and infection are postulated to be lesser in some other studies. We conducted a retrospective study in the department of colorectal surgery, Christian Medical College; Vellore from 2011 to 2017 to compare the perineal wound-related complications following CAPE and ELAPE. The data were retrieved from the prospectively maintained computerized inpatient and out-patient follow up records and comparisons were made in terms of incidence of perineal wound outcomes, need for reoperations and duration of hospital stay. A total of 138 patients underwent CAPE and 57 patients underwent ELAPE over a period of 7 years. There was no statistical difference in baseline characteristics and patients who underwent neo-adjuvant chemoradiation between the two groups. Perineal wound complications were seen in 63% (87) of the patients after CAPE compared to 64.9% (37) of the patients after ELAPE. There was no perineal herniation or wound dehiscence following ELAPE, whereas these complications occurred in 1 and 5 patients respectively after CAPE. Similarly, the incidence of reoperations was 8% in CAPE as compared to 5.4% in ELAPE although not statistically significant. There was no difference in the length of hospital stay. Hence, in our experience, perineal wound complications were similar in the Extralevator approach to APE (ELAPE) as compared to conventional APE (CAPE) for rectal adenocarcinoma.