Neoplasm Recurrence, Local, Postoperative Complications, Rectal Cancer, Survival Rate, Treatment
Conditions
Keywords
cylindrical abdominoperineal resection, rectal cancer, acellular dermal matrix, pelvic reconstruction, circumferential resection margin, overall survival
Brief summary
The purpose of this study is to determine whether cylindrical abdominoperineal resection is effective in the treatment of advanced very low rectal cancer
Detailed description
Abdominoperineal resection (APR) is still a common operation in patients with tumours less than 6 cm from the anal verge. The perineal phase of APR is a difficult part of the operation, often done with the patient in the supine position.The risk of inadvertent bowel perforation is high, the resulting specimen frequently has a waist at the lower border of the mesorectum, and the circumferential resection margin (CRM) is often close to the rectal muscle tube. The cylindrical APR may be performed via an extended posterior perineal approach, that aims to create a more cylindrical specimen without a waist. The potential benefit of this technique is a reduction in the risk of bowel perforation and tumour involvement of the CRM, and thus in the risk of local recurrence. Perineal wounds in patients following APR are at considerable risk for infection, dehiscence and delayed healing when closed primarily. This can be further increased in patients who have received neoadjuvant chemoradiation therapy. The adoption of extended resection, such as the cylindrical APR, may cause additional risks. The use of acellular biomaterials, including human acellular dermal matrix (HADM) has drawn great interest for the complex abdominal wall reconstruction. The purpose of this study is to determine whether cylindrical abdominoperineal resection is effective in the treatment of advanced very low rectal cancer, and to determine the initial results of pelvic reconstruction using human acellular dermal matrix after cylindrical abdominoperineal resection.
Interventions
PROCEDUREcylindrical abdominoperineal resection
Extended abdominoperineal resection with human acellular dermal matrix reconstruction of the pelvic floor for rectal cancer
Sponsors
Shandong Provincial Hospital
Shandong Cancer Hospital and Institute
The First Affiliated Hospital of Zhengzhou University
Wuhan University
Shenyang Anorectal Hospital
Beijing Luhe Hospital
Beijing Chao Yang Hospital
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Tumor within 6 cm of the anal verge, or with very narrow pelvis * T3-T4 as determined by preoperative MRI or endorectal ultrasonography examination, or a low tumor is fixed or tethered at rectal examination * Absence of distant metastases * Absence of intestinal obstruction
Exclusion criteria
* T1-T2 as determined by preoperative MRI or endorectal ultrasonography examination * with distant metastases * with intestinal obstruction * pregnancy or lactation * allergic constitution to heterogeneous protein * with operation contraindication * with mental disorder
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| postoperative complications | 08/01/2011 |
Secondary
| Measure | Time frame |
|---|---|
| 3-years overall survival | 08/01/2013 |
Countries
China
Contacts
Primary ContactZhen Jun Wang, M.D.
Backup ContactJia Gang Han, M.D.
Outcome results
None listed