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.

The hypotheses

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.

Endpoints

Primary:

-       Local recurrence rate at 3 years

Secondary

-       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

Inclusion criteria

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

-       Informed consent

Inclusion:

Concluded, 1319 patients

Documents

Study Protocol (click name to download): APER 

Publications:

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

-       Angenete E, Correa-Marinez A, Heath J, Gonzalez E, Wedin A, Prytz M, Asplund D, Haglind E: Ostomy function after abdominoperineal resection--a clinical and patient evaluation. Int J Colorectal Dis 2012;27:1267-1274.

-       Asplund D, Haglind E, Angenete E: Outcome of extralevator abdominoperineal excision compared with standard surgery: results from a single centre. Colorectal Dis 2012;14:1191-1196.

Contact

Principal investigator:

Eva Haglind

Deputy principal investigator:

Eva Angenete

Questions:

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