ArticleAnnals of gastroenterological surgery2026
Extralevator Abdominoperineal Excision Improves Overall Survival Compared to Standard Abdominoperineal Excision: A Systematic Review and Meta-Analysis.
Article in Annals of gastroenterological surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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8 authors.
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Abstract
Background: In advanced low rectal cancer, the surgical technique chosen can affect long-term oncological outcomes. Extralevator abdominoperineal excision (ELAPE) was developed to improve radicality compared with standard abdominoperineal excision (APE). Although earlier analyses suggested reduced local recurrence and mortality with ELAPE, its survival benefit remains debated, and concerns about wound complications persist. This meta-analysis compared ELAPE and APE, focusing on oncological outcomes. Methods: The protocol was registered on PROSPERO (CRD42023412308). A systematic search of PubMed, Embase, and CENTRAL was performed (April 14, 2023). Comparative studies of ELAPE versus APE were included. Data were synthesized using random-effects models. For overall survival (OS), disease-free survival (DFS), and local recurrence-free survival (LRFS), hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated, with individual patient data extracted from Kaplan-Meier curves. Results: Thirty-eight studies, including over 5000 patients, were analyzed. ELAPE reduced mortality by 46% (HR 0.54, 95% CI 0.40-0.73) and achieved a 5-year OS of 83% (CI 0.53-0.95) versus 69% (CI 0.40-0.88) for APE. ELAPE improved DFS (HR 0.74, 95% CI 0.55-0.99), with a 5-year DFS of 87% (CI 0.50-0.98) compared with 65% (CI 0.24-0.92) for APE. LRFS favored ELAPE but was not significant (HR 0.67, 95% CI 0.45-1.00). Rates of perineal wound complications did not differ (OR 1.39, 95% CI 0.81-2.40). Conclusion: ELAPE improves OS and DFS compared with APE without increasing wound complications. These findings support the broader application of ELAPE in rectal cancer treatment.
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