See the published version of this article at BMC Surgery.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
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Research article
Ben Liu
Royal Wolverhampton Hospitals NHS Trust
Corresponding Author
ORCiD: https://orcid.org/0000-0002-4406-5012
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Surgery.
Background:
Lymph node (LN) harvest in colorectal cancer resections is a well-recognised prognostic factor for disease staging and determining survival, particularly for node-negative (N0) diseases.
Extralevator abdominoperineal excisions (ELAPE) aim to prevent “waisting” that occurs during conventional abdominoperineal resections (APR) for low rectal cancers, and reducing circumferential resection margin (CRM) infiltration rate. Our study investigates whether ELAPE may also improve the quality of LN harvests, addressing gaps in the literature.
Methods:
This retrospective observational study reviewed 2 sets of 30 consecutive APRs before and after the adoption of ELAPE in our unit.
The primary outcomes are the total LN count and rates of meeting the standard of 12-minimum, particularly for those with node-negative disease. The secondary outcomes are the CRM involvement rates.
Baseline characteristic including age, sex, laparoscopic or open surgery and neoadjuvant chemoradiotherapy were accounted for in our analyses.
Results:
Median LN counts were slightly higher in the ELAPE group (16.5 vs. 15). Specimens failing the minimum 12-LN requirements were almost significantly fewer in the ELAPE group (OR=0.456). Among node-negative rectal cancers, significantly fewer resections failed the 12-LN standard in the ELAPE group than APR group (OR=0.211, p=0.044). ELAPE led to a near-significant decrease in CRM involvement (OR=0.365). These improvements were persistently observed after taking into account baselines and potential confounders in regression analyses.
Conclusion
ELAPE provides higher quality of LN harvests that meet the 12-minimal requirements than conventional APR, particularly in node-negative rectal cancers. The superiority is independent of potential confounding factors and may implicate better clinical outcomes.
Keywords
Rectal cancers, abdominoperineal excisions, lymph nodes, histopathology
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CURRENT STATUS: Published
Version 1
Posted 20 May, 2020
Published
On 16 Oct, 2020
No community comments so far
Review #4 received
Received 17 Aug, 2020
Editorial decision: Major revision
On 17 Aug, 2020
Reviewer #4 agreed
On 14 Aug, 2020
Review #3 received
Received 11 Aug, 2020
Reviewer #3 agreed
On 11 Jul, 2020
Reviewer #2 agreed
On 08 Jul, 2020
Review #2 received
Received 08 Jul, 2020
Review #1 received
Received 27 Jun, 2020
Reviewer #1 agreed
On 09 Jun, 2020
Reviewers invited
Invitations sent on 08 Jun, 2020
Editor assigned
On 12 May, 2020
First submitted
On 11 May, 2020
Submission checks complete
On 11 May, 2020
Editor invited
On 11 May, 2020
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This preprint is under consideration at BMC Surgery. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Ben Liu
Royal Wolverhampton Hospitals NHS Trust
Corresponding Author
ORCiD: https://orcid.org/0000-0002-4406-5012
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 1
Posted 20 May, 2020
Published
On 16 Oct, 2020
No community comments so far
Review #4 received
Received 17 Aug, 2020
Editorial decision: Major revision
On 17 Aug, 2020
Reviewer #4 agreed
On 14 Aug, 2020
Review #3 received
Received 11 Aug, 2020
Reviewer #3 agreed
On 11 Jul, 2020
Reviewer #2 agreed
On 08 Jul, 2020
Review #2 received
Received 08 Jul, 2020
Review #1 received
Received 27 Jun, 2020
Reviewer #1 agreed
On 09 Jun, 2020
Reviewers invited
Invitations sent on 08 Jun, 2020
Editor assigned
On 12 May, 2020
First submitted
On 11 May, 2020
Submission checks complete
On 11 May, 2020
Editor invited
On 11 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Surgery.
Background:
Lymph node (LN) harvest in colorectal cancer resections is a well-recognised prognostic factor for disease staging and determining survival, particularly for node-negative (N0) diseases.
Extralevator abdominoperineal excisions (ELAPE) aim to prevent “waisting” that occurs during conventional abdominoperineal resections (APR) for low rectal cancers, and reducing circumferential resection margin (CRM) infiltration rate. Our study investigates whether ELAPE may also improve the quality of LN harvests, addressing gaps in the literature.
Methods:
This retrospective observational study reviewed 2 sets of 30 consecutive APRs before and after the adoption of ELAPE in our unit.
The primary outcomes are the total LN count and rates of meeting the standard of 12-minimum, particularly for those with node-negative disease. The secondary outcomes are the CRM involvement rates.
Baseline characteristic including age, sex, laparoscopic or open surgery and neoadjuvant chemoradiotherapy were accounted for in our analyses.
Results:
Median LN counts were slightly higher in the ELAPE group (16.5 vs. 15). Specimens failing the minimum 12-LN requirements were almost significantly fewer in the ELAPE group (OR=0.456). Among node-negative rectal cancers, significantly fewer resections failed the 12-LN standard in the ELAPE group than APR group (OR=0.211, p=0.044). ELAPE led to a near-significant decrease in CRM involvement (OR=0.365). These improvements were persistently observed after taking into account baselines and potential confounders in regression analyses.
Conclusion
ELAPE provides higher quality of LN harvests that meet the 12-minimal requirements than conventional APR, particularly in node-negative rectal cancers. The superiority is independent of potential confounding factors and may implicate better clinical outcomes.
Figure 1
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