Laparoscopic Extralevator Abdominoperineal Excision: Experience from a Single Center

  Objective  To investigate the feasibility of extralevator abdominoperineal excision (ELAPE) under laparoscope.

  Methods  We retrospectively analyzed 12 patients with distal rectal cancer who underwent ELAPE in our center from June 2012 to August 2013. During the procedures, the levator ani muscles were cut off laparoscopically at its origin at both sides on the pelvic wall, and its attachment on coccyx was removed posteriorly. The dissection plane was taken along the Denonvillier fascia anteriorly as far as possible to the perineal body. The adjacent organs were removed if invaded by the tumors. The anus and its surrounding tissue were removed by perineal approach without changing patients' positions. The pelvic perinium was closed laparoscopically to prevent the intestine dropping. The operation time, blood loss, retrieval of lymph nodes, radial margin, and postoperative complications were recorded.

  Results  The patients aged (65.2±12.5)years and their body mass index was 21.6±3.1. The distance from lower edge of tumor to anal verge was (3.3±0.7)cm. The procedure lasted (176.1±27.5) minutes, with a blood loss of (49.6±38.2)ml. The average number of node retrieval was 18.3±7.8, and no positive radial margin was identified. The postoperative complications included urinary retention in 2 patients. The perineal incision appeared to be class A healing in 9 patients.

  Conclusion  By extensively removing the levator ani muscles laterally and posteriorly, ELAPE procedure can be accomplished under laparoscope without changing operative position or flap repair of the pelvic floor.