Amputação abdominoperineal extraelevador – Revisão

Total mesorectal excision (TME) has considerably decreased rectal cancer local recurrence rates to 5 to 15%. However oncologic outcomes of rectal cancer treated with abdominoperineal excision remained worse (with local recurrence rates around 40%) than those treated with TME. Positive circumferential resection margins and intraoperative perforation seemed to be the major responsibles for the worse overall survival in these patients. Holm et al described extralevator abdominoperineal excision a technic with a wider perineal dissection, in order to overcome these issues. We conducted a literature review on the oncological outcomes and surgical complications of ELAPE and conventional abdominoperineal excision. The recognition that conventional abdominoperineal excision was a bad oncological surgery and the description of ELAPE shifted the main focus of this surgery back to the perineal part in order toachieve local recurrence rates equal to those of TME. The literature confirms that ELAPE has very good oncological results with the decrease of local recurrence rates. Regarding surgical complications, there seems to be no difference between ELAPE and conventional abdominoperineal excision. ELAPE is a promising technique, which improves overall survival in patients with rectal cancer.