Abdominoperineal Resection in the United Kingdom: a Case against Centralisation.

Abdominoperineal excision of the rectum (APER) is associated with poorer oncological outcomes compared to anterior resection due to higher rates of involved circumferential resection margins, intra-operative perforations and local recurrence. Centralisation of rectal cancer treatment in the United Kingdom has been suggested to improve APER outcomes; however, it risks unnecessarily increasing the travel burden for patients and de-skilling district general hospital surgeons who may have the necessary expertise. This study reports the outcomes of a single-centre UK district general hospital over a 9-year period. All patients undergoing APER for rectal cancer between November 2011 and November 2020 in a single UK district general hospital were analysed, including pre-operative staging and neoadjuvant treatment, histology, recurrence and survival. A total of 77 APERs were analysed over the study period with an average age of 69 years (41–86). Neoadjuvant radiotherapy was used in 49 (63.6%) patients, and median follow-up time was 39 months (0–107). The involved circumferential resection margin (CRM) rate was 10/77 (13.0%), while the intra-operative perforation rate was 5/77 (6.5%), and both were associated with worse disease-free survival (p = 0.003 and p = 0.001, respectively). Local and distant recurrence rates were 4/77 (5.2%) and 17/77 (22.1%), respectively. This study reports comparable oncological outcomes to larger UK-based single-centre studies, suggesting there remains a role for APER in selected non-tertiary centres by surgeons possessing the appropriate skillset. Both involved circumferential resection margin and intra-operative perforation are associated with decreased disease-free survival but not local recurrence. [ABSTRACT FROM AUTHOR]