ORIGINAL RESEARCH article
Front. Surg.
Sec. Colorectal and Proctological Surgery
This article is part of the Research TopicEvaluating surgical techniques and perioperative strategies in colorectal cancer treatmentView all 15 articles
Flap Reconstruction in Rectal Resection and Exenteration Surgery: A Single Centre Retrospective Cohort Study
Provisionally accepted
Jonathan Tebabu Wubetu1,2*
Valentin Butnari3,4*Ahmer Mansuri1Gursharan Paul Singh Bawa1Baskaran Sabapathipillai1Richard Boulton1Saswata Banerjee1Matthew Hanson1Joseph Huang1David Burling5Sandeep Kaul1Manu Sood6Rishabh Bassi1Waseemullah Khan6Nirooshun Rajendran1,4- 1Barking Havering and Redbridge University Hospitals NHS Trust, Romford, United Kingdom
- 2University of Glasgow, Glasgow, United Kingdom
- 3Barts Health NHS Trust, London, United Kingdom
- 4Queen Mary University of London Blizard Institute, London, United Kingdom
- 5St Mark's the National Bowel Hospital and Academic Institute, London, United Kingdom
- 6Plastic and Reconstructive Surgery Department, Mid and South Essex NHS Foundation Trust, Basildon, United Kingdom
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Purpose: To evaluate the outcomes of flap reconstruction following extralevator abdominoperineal excision (ELAPE) compared to abdominoperineal resection (APR) in the treatment of locally advanced and recurrent rectal cancer, in the context of demonstrating the feasibility of performing ELAPE with flap reconstruction for rectal cancer in a large public (non-tertiary) hospital. The primary outcome was the assessment of postoperative complication rates to determine whether outcomes fell within acceptable standards for complex pelvic reconstruction. Secondary outcomes included flap-specific complications, operative parameters, postoperative length of stay, and correlations between flap complexity, operative duration, complication grade, and recovery metrics. Methods: This retrospective cohort study analysed 39 patients who underwent reconstructive ELAPE or APR at a secondary referral centre between April 2018 and August 2024. Data were collected from a prospectively maintained database and validated using clinical records and MDT meeting summaries. Patient demographics, surgical details, flap types, postoperative outcomes, and complication rates were evaluated. Statistical analyses included descriptive statistics and correlation assessments. Results: Twenty-seven patients underwent ELAPE with flap reconstruction, utilizing vertical rectus abdominis myocutaneous (VRAM), inferior gluteal artery (IGAM), gracilis, and V-Y advancement flaps. Outcomes, including complication rates and length of hospital stay, were comparable to those reported by tertiary centres. Major complications (Clavien-Dindo grade III and above) occurred in 33.3% of ELAPE cases, with flap-specific complications such as superficial infections (14.8%) and dehiscence requiring intervention (7.4%). Median length of stay for ELAPE was 18 days. No cases of complete flap failure were observed. Conclusion: This study demonstrates that ELAPE with flap reconstruction can be safely and effectively performed in a large public hospital setting, with outcomes comparable to high-volume tertiary centres. The findings underscore the importance of multidisciplinary collaboration in achieving high-quality surgical and reconstructive outcomes, and how these can be achieved in a large public hospital. Keywords (MeSH): Rectal Cancer, Extralevator Abdominoperineal Excision (ELAPE), Abdominoperineal resection (APR), Flap Reconstruction, Multidisciplinary Care
Keywords: Abdomino perineal excision (APE), Abdomino perineal resection, ELAPE, Extralevator abdominoeperineal excision (ELAPE), Flap reconstruction, multidisciplinary care, rectal cancer
Received: 21 Sep 2025; Accepted: 16 Jan 2026.
Copyright: © 2026 Wubetu, Butnari, Mansuri, Bawa, Sabapathipillai, Boulton, Banerjee, Hanson, Huang, Burling, Kaul, Sood, Bassi, Khan and Rajendran. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jonathan Tebabu Wubetu
Valentin Butnari
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