APE stands for ‘abdomino-perineal excision’ – originally the standard surgical operation for rectal cancer in the twentieth century. This procedure establishes a permanent colostomy in patients.
During the second half of the century, the feasibility of removing rectal cancers without sacrifice of the anal sphincters steadily increased, so that the incidence of APE has now reduced from almost 100% of rectal cancers down to between around 10-50% (this varies according to the centre and the specific views of the surgeon to whom the patient is referred).
This variability within the United Kingdom has been the subject of a recent paper by the Pelican faculty member, Professor Phil Quirke, who has drawn attention to the fact that there is a degree of ‘postcode lottery’ about whether a given patient with a given tumour at a certain height will receive a sphincter-preserving operation or an APE.
This variability underpins Pelican’s advice that any patient who is reluctant to undergo a permanent colostomy should not feel embarrassed to request a second opinion from a surgeon who may be more inclined towards sphincter preservation.
Recent Pelican initiatives regarding low rectal cancer include:
In October 2010, Mr Brendan Moran became the National Clinical Lead for the Low Rectal Cancer Development Programme (LOREC). The objective of this programme is to help the colorectal multi-disciplinary team recognise the complexity of low rectal cancer and carefully consider the most appropriate treatment for each individual patient. For more information about the programme, visit the LOREC website.
One of Pelican’s principle research projects at the moment embraces this particular “hot topic”. This study is called the Low Rectal Cancer Study , and work is based at the Pelican Centre under the project leadership of Mr Brendan Moran and Professor Gina Brown.