Abdomino Perineal Extralevator Resection (APER)


The primary aim of the study is to compare the primary- and secondary end-points after extralevator abdominoperineal excision with standard abdominoperineal excision. The quality registry for colorectal cancer will be used to retrieve information about the index operation, pathology report, recurrent disease and survival of a three-year cohort, consisting of all patients who underwent APR in Sweden in 2007, 2008 and 2009.


Extralevator perineal excision in APR for rectal cancer will:

-       Decrease local recurrence at 3 years.

-       Increase postoperative morbidity.

-       Improve late morbidity.

-       Improve quality of life at 36-48 months postoperatively.

-       Increase resource consumption in comparison with the traditional perineal excision technique used in APR.



  • Local recurrence rate at 3 years.


  • Postoperative morbidity, Wound infection, Deep infections, Other infections, Wound necrosis, Pain, Pneumonia, Thrombosis.
  • Re-operation/s, length of hospital stay/s, re-admittance/s and mortality, all within 12 months of primary surgery.
  • Late morbidity and functional disorders: prolonged wound healing, late infections, limping, pain, sitting problems, urinary incontinence, erectile dysfunction, stoma related dysfunction.
  • Patient experienced health and QoL 24-48 months postoperatively.
  • Health economic analysis of resource consumption.


Inclusion criteria:

  • All patients registered in the colorectal cancer registry as operated by APR during 2007, 2008 and 2009.
  • Informed consent.

Exclusion criteria:

  • No informed consent received.

Inclusion of patients:

Concluded, 1319 patients.


Protocol (click on name to view/download): APER 


Urogenital function 3 years after abdominoperineal excision for rectal cancer.
Ledebo A, Bock D, Prytz M, Haglind E, Angenete E.
Colorectal Disease 2018;20(6):O123-34.

Association between operative technique and intrusive thoughts on health-related Quality of Life 3 years after APE/ELAPE for rectal cancer: results from a national Swedish cohort with comparison with normative Swedish data.
Prytz M, Ledebo A, Angenete E, Bock D, Haglind E.
Cancer Medicine 2018;7(6):2727-35.

Extralevator abdominoperineal excision (ELAPE) for rectal cancer-short-term results from the Swedish Colorectal Cancer Registry. Selective use of ELAPE warranted.
Prytz M, Angenete E, Ekelund J, Haglind E.
Int J Colorect Dis 2014;29:981-7.

Ostomy function after abdominoperineal resection--a clinical and patient evaluation.
Angenete E, Correa-Marinez A, Heath J, Gonzalez E, Wedin A, Prytz M, et al.
Int J Colorect Dis 2012;27:1267-74.

Outcome of extralevator abdominoperineal excision compared with standard surgery: results from a single centre.
Asplund D, Haglind E, Angenete E.
Colorectal Dis 2012;14:1191-6.

Abdominoperineal extralevator resection.
Prytz M, Angenete E, Haglind E.
Dan Med J 2012;59:A4366.


Principal investigator:

Eva Haglind

Deputy principal investigator:

Eva Angenete


Doctoral student Mattias Prytz (mattias.prytz@vgregion.se) or research nurse Anette Wedin (anette.wedin@vgregion.se)