ELAPE: rol actual en el tratamiento del cáncer de recto bajo / ELAPE: current role in the treatment of low rectal cancer

Resumen En este artículo se discute el origen del concepto ELAPE ( extralevator abdominoperineal excision) en el tratamiento quirúrgico del cáncer del recto bajo, las variantes técnicas asociadas con la resección "cilíndrica", las indicaciones actuales, las limitaciones técnicas asociadas y los resultados publicados en la literatura mundial. Considerando la evidencia actual se propone la utilización en casos seleccionados de acuerdo al estudio clínico y por imágenes, donde la resonancia magnética de la pelvis tiene un rol predominante. La técnica tradicional de la amputación abdominoperineal (comúnmente asociada a Miles) se mantiene como una alternativa válida en el manejo quirúrgico de algunos pacientes con un tumor localmente avanzado del recto bajo.

This article discusses the origin of the ELAPE concept (abdominoperineal excision extralevator) in the surgical treatment of low rectal cancer, the technical variants associated with "cylindrical" resection, current indications, associated technical limitations and the results published in the world literature Considering the current evidence, the use is proposed in selected cases according to the clinical study and imaging, where the magnetic resonance of the pelvis has a predominant role. The traditional abdominal-perineal amputation technique (commonly associated with Miles) remains a valid alternative in the surgical management of some patients with a locally advanced tumor of the lower rectum.

Reconstrucción perineal con colgajo miocutáneo vertical de recto anterior del abdomen luego de amputación abdomino perineal extraelevador. Una alternativa factible para el cirujano colorrectal / Perineal reconstruction with vertical myocutaneous flap of the anterior rectus abdominis after extra-elevating perineal abdominal amputation. A feasible alternative for the colorectal surgeon

Las complicaciones perienales luego de la amputación abdominoperineal son frecuentes y clínicamente relevantes en términos de estadía hospitalaria, costos, calidad de vida y los resultados oncológicos. La utilización creciente de radioterapia pre operatoria y la incorporación gradual a la técnica extra-elevador, ha llevado a un aumento en la morbilidad perineal. Es por elloque la búsqueda de una técnica confiable y con buenos resultados para el cierre perineal se hace necesaria. Se han publicado muchas series que describen diferentes técnicas de cierre del defecto perineal, pero faltan estudios clínicos de alta calidad que indiquen cuál es la mejor opción. Cuando la proctectomía resulta en un amplio defecto perineal, el colgajo vertical del recto del abdomen parece ser la mejor opción. Presentamos dos casos de tumores anorectales localmente avanzados en los que se realizó una amputación abdominoperineal extraelevador con posterior reconstrucción perineal con colgajo de recto anterior y, a su vez, describimos la técnica quirúrgica. (AU)

Perineal complications after abdominoperineal amputation are frequent and clinically relevant in terms of hospital stay, costs, quality of life and oncological results. The growing utilization of pre-operative radiotherapy and the gradual incorporation to the extra-elevator technique, has leaded to an increase in perineal morbidity. That is why the search for a reliable technique with good postoerative outcomes for the perineal closure is necessary. Many series describing different closure techniques of the perineal defect have been published, but high quality clinical studies have to indicate which the best option is. When the proctectomy results in a wide perineal defect, the vertical rectus abdominis flap seems to be the best option. We presented two cases of locally advanced anorectal tumors in which an extraelevatory abdominoperineal amputation was carried out with posterior perineal reconstruction with vertical rectus abdomins flap and we described the surgical technique. (AU)

Finite element analysis of the effect of unilateral extralevator abdominal-perineal excision on the pelvic floor / 天津医药

Objective To evaluate the effects of unilateral extralevator abdominal-perineal excision (ELAPE) surgery and the ELAPE surgery on the pelvic floor detected by finite element analysis. Methods Three kinds of finite element mod?el were developed:the intact model, ELAPE model and the unilateral ELAPE model. The maximal stress and stress distribu?tions of each model under the same pressure were analyzed and compared. Results In the unilateral ELAPE model, non-le?vator ani tissue’s maximal stress on the levator ani reserved side was lower than that in ELAPE model, and was similar to that in the intact model. Its maximal stress on the excised side was lower than that in ELAPE model, and which was higher than that of intact model. Its maximal stress on the reserved side was lower than that of on the excised side. Conclusion Compared to the ELAPE surgery, the unilateral ELAPE surgery is able to reduce the stress of non-levator ani tissue on both sides, especially on the levator ani reserved side.