Thesis (Ph.D.) - Cairo University - National Cancer Institute - Department of Oncology (Surgical)

Background: In the literature, the Standard Abdomino-Perineal Excision (SAPE) is associated with high incidence of Intra-Operative Bowel Perforation (IOBP) and positive Circumferential Resection Margin (CRM) , both are major determinants of local recurrence. This led to introduction of a more radical surgery ,the Extralevator Abdomino-Perineal Excision (ELAPE), which improves the oncological outcomes of low rectal cancer surgery . The question whether this technique may confer an additional morbidity was investigated by many retrospective , single- and multi-institutional analysis which compared ELAPE and SAPE regarding their short term complications and more importantly their oncological outcome. Methods:This is a prospective randomized controlled trial that has been carried out in the National Cancer Institute (NCI), Cairo University , Egypt over the period of 42 months. Patients were randomized into 2 groups , 20 patients each. Group A: Patients treated with (ELAPE), and Group B: Patients treated with (SAPE). In both groups, each patient was followed for a period of 24 months .Data was extracted prospectively . The main endpoints of comparison between the two groups were the intra-operative factors including Estimated Blood Loss (EBL) , Operative time and IOBP, early post operative complications , Pathological factors and margin assessment and more importantly the oncological outcomes (CRM and Local Recurrence). Results:Patients{u2019} demographics and co-morbidities were comparable between the two groups . Operative time and EBL were comparable.There was significant statistical difference between the two groups regarding inadvertent IOBP (1 patient in Group A 25%3 vs 7 patients in Group B 235%3 with p-value = 0.044)

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