Standard abdomino-perineal resection for low rectal cancer. Are we doing it right? Results from a District General Hospital, United Kingdom

Aims: Standard Abdomino- perineal Resection (SAPER) for low rectal cancer, has attracted criticism due to the perceived high margin positivity and subsequent impact on local recurrence and survival. Extralevator APER (ELAPE) has been proposed as a better technique. However there is an ongoing debate between the two techniques because of the higher morbidity associated with an ELAPE operation.The aim of this study is to evaluate our outcomes after a standard APER in terms of circumferential resection margins (CRM) positivity and local recurrence. Methods: This is a retrospective cohort study: data was collected for patients undergoing a SAPER between the periods of 2005-2009. We collected demographics along with radiological, pathological, oncological and operative details. Primary outcome measures were circumferential margin positivity (defined as CRM <1 mm) and localized recurrence. Five year survival rates were also calculated. Results: Fifty seven patients underwent a standard APER between the periods of 2005 and 2009 (M:F 38:19). The mean age was 65 (range 39-84). Forty-seven procedures were open, 8 lap and 2 conversions. Postoperative pathology showed a CRM positivity in 7 out of 56 patients (12.5%). Within the 5 year FU period 6 patients had local recurrence (10%) and 13 had distant metastases (22%). Five-year survival for the whole group was 68.4%. 43/57 (75%) of patients had no complications within 30 days of their operation. Conclusions: Standard APER can be carried out with acceptable results in terms of resection margin positivity and local recurrence rates. ELAPE should be further investigated in RCT's.