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Vol. 33. Num. 3.July - September 2013
Pages 111-178
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Vol. 33. Num. 3.July - September 2013
Pages 111-178
Review article
DOI: 10.1016/j.jcol.2013.08.003
Open Access
Cylindrical abdominoperineal resection rationale, technique and controversies
Amputação abdominoperineal cilíndrica racional, técnica e controvérsias
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Patricio B. Lynna, Angelita Habr-Gamaa, Rodrigo O. Pereza,b,
Corresponding author
Rodrigo.operez@gmail.com

Corresponding author.
, Esteban Grzonac, Charles Sabbaghd, Joaquim J. Gama-Rodriguesa
a Angelita & Joaquim Gama Institute, São Paulo, SP, Brazil
b University of São Paulo School of Medicine, Gastroenterology Department, Colorectal Surgery Division, São Paulo, SP, Brazil
c Hospital Alemán de Buenos Aires, Surgery Division, Buenos Aires, Argentina
d Service de Chirurgie Viscérale et Digestive, Hôpital Nord, CHU d’Amiens, place Victor-Pauchet, France
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Article information
Abstract

Surgery remains the cornerstone in rectal cancer treatment. Abdominoperineal excision (APE), described more than 100 years ago, remains as an important procedure for the treatment of selected advanced distal tumors with direct invasion of the anal sphincter or preoperative fecal incontinence. Historically, oncological outcomes of patients undergoing APE have been worse when compared to sphincter preserving operations. More recently, it has been suggested that patients undergoing APE for distal rectal cancer are more likely to have positive circumferential resection margins and intraoperative perforation, known surrogate markers for local recurrence. Recently, an alternative approach known as “Extralevator Abdominoperineal Excision” has been described in an effort to improve rates of circumferential margin positivity possibly resulting in better oncological outcomes compared to the standard procedure. The objective of this paper is to provide a technical description and compare available data of both Extralevator and Standard abdominal perineal excision techniques.

Keywords:
Rectal cancer
Total mesorectal excision
Abdominoperineal excision
Extralevator Abdominoperineal excision
Cilindric abdominoperineal excision
Resumo

Um dos pilares mais importantes no tratamento do câncer de reto ainda é a ressecção cirúrgica. A amputação de reto, ou excisão abdomino-perineal do reto (APE), descrita há mais de 100 anos, continua sendo um procedimento importante para o tratamento de tumores retais distais que invadem o aparelho esfincteriano ou em casos de incontinência pré-operatória. Entretanto, os resultados oncológicos dos pacientes submetidos à APE são piores quando comparados com os pacientes submetidos a procedimentos com preservação esfincteriana. Recentemente, foi sugerido que os pacientes submetidos à APE por câncer de reto distal apresentam mais frequentemente margem radial positiva, assim como perfuração intraoperatória do tumor, fatos reconhecidamente associados à recidiva local. Uma nova técnica cirúrgica conhecida como “Amputação de reto extraelevador ou cilíndrica” tem sido descrita em um esforço para reduzir as taxas de margem radial positivas, sugerindo melhores resultados oncológicos quando comparada com o procedimento convencional. O objetivo deste trabalho é descrever a técnica deste procedimento e comparar seus resultados com os obtidos com a técnica convencional de acordo com a evidência disponível.

Palavras-chave:
Câncer de reto
Excisão total do mesorreto
Amputação abdominoperineal
Amputação abdominoperineal extraelevador
Amputação cilíndrica
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Copyright © 2013. Sociedade Brasileira de Coloproctologia
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