P-0291 Factors Which Influenced Waisting, Perforation, and Circumferential Resection Margin Positivity in the Abdominoperineal Resection Specimen

Abstract

ABSTRACT Introduction This study aimed to compare the surgery – related outcomes specifically the incidence of circumferential resection margin (CRM) involvement, waisting, and iatrogenic perforation of the surgical specimen; and the peri – operative outcomes of patients with primary distal rectal cancer who underwent either an extralevator or a conventional abdominoperineal resection (APR). Methods This was a retrospective study conducted by the Division of Colorectal Surgery at the University of the Philippines – Philippine General Hospital that analyzed eighty six adult patients who underwent APR due to primary distal rectal cancer from January 1, 2008 to December 31, 2011. Variables pertinent to surgery – related and peri – operative outcomes were gathered, recorded, and analyzed. Results An en bloc APR with hysterectomy and posterior vaginectomy (p=0.021) was found to be statistically significant factor associated with an increased incidence of waisting in APR specimens. On the other hand, an en bloc APR with hysterectomy and posterior vaginectomy (p=0.012); and the tumor height of 2 cm from the anal verge (p=0.028) had significant influenced on iatrogenic perforation. With regard to CRM positivity, the male gender (p=0.021) and a higher pathologic T classification (p=0.013) were found to be statistically significant factors. An extralevator APR led to a statistically – significant decrease in the incidence of waisting in the surgical specimen (p=0.020) and CRM involvement (p=0.044) when compared to the conventional technique. Conclusion An extralevator APR may lead to improved oncologic outcomes in patients with primary distal rectal cancer based on a statistically significant decrease in surgical specimen waisting and CRM positivity when compared to the conventional approach.