Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2018; 24(30): 3440-3447
Published online Aug 14, 2018. doi: 10.3748/wjg.v24.i30.3440
Application of modified primary closure of the pelvic floor in laparoscopic extralevator abdominal perineal excision for low rectal cancer
Yan-Lei Wang, Xiang Zhang, Jia-Jia Mao, Wen-Qiang Zhang, Hao Dong, Fan-Pei Zhang, Shuo-Hui Dong, Wen-Jie Zhang, Yong Dai
Yan-Lei Wang, Xiang Zhang, Jia-Jia Mao, Wen-Qiang Zhang, Hao Dong, Fan-Pei Zhang, Shuo-Hui Dong, Wen-Jie Zhang, Yong Dai, Department of Colorectal and Anal Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
Author contributions: Wang YL and Dai Y designed the study; Wang YL, Zhang X and Dai Y performed the surgery; Mao JJ performed subject follow up and control subject data collection; Zhang WQ and Dong SH performed the statistical analysis; Zhang X, Zhang FP, Dong H and Zhang WJ wrote the manuscript; Wang YL, Zhang X, Mao JJ, Zhang WQ, Dong H, Zhang FP, Dong SH, Zhang WJ, Dai Y revised the manuscript for final submission.
Supported by the National Key and Development Program of China, No. 2016YFC0106003; the National Natural Science Foundation of China, No. 81700708/H0712; and the Key and Development Program of Shandong Province, No. 2016GSF201125.
Institutional review board statement: This study was approved by the Ethics Committee of Scientific Research of Shandong University Qilu Hospital.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest related to this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yong Dai, MD, PhD, Attending Doctor, Chief Doctor, Surgeon, Department of Colorectal and Anal Surgery, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan 250012, Shandong Province, China. yongdai@hotmail.com
Telephone: +86-531-82166391
Received: May 31, 2018
Peer-review started: May 31, 2018
First decision: June 15, 2018
Revised: June 18, 2018
Accepted: June 30, 2018
Article in press: June 30, 2018
Published online: August 14, 2018
Processing time: 74 Days and 1.3 Hours
Abstract
AIM

To introduce a novel, modified primary closure technique of laparoscopic extralevator abdominal perineal excision (LELAPE) for low rectal cancer.

METHODS

We retrospectively analyzed data from 76 patients with rectal cancer who underwent LELAPE from March 2013 to May 2016. Patients were classified into the modified primary closure group (32 patients) and the biological mesh closure group (44 patients). The total operating time, reconstruction time, postoperative stay duration, total cost, postoperative complications and tumor recurrence were compared.

RESULTS

All surgery was successfully performed. The pelvic reconstruction time was 14.6 ± 3.7 min for the modified primary closure group, which was significantly longer than that of the biological mesh closure group (7.2 ± 1.9 min, P < 0.001). The total operating time was not different between the two groups (236 ± 20 min vs 248 ± 43 min, P = 0.143). The postoperative hospital stay duration was 8.1 ± 1.9 d, and the total cost was 9297 ± 1260 USD for the modified primary closure group. Notably, both of these categories were significantly lower in this group than those of the biological mesh closure group (P = 0.001 and P = 0.003, respectively). There were no differences observed between groups when comparing other perioperative data, long-term complications or oncological outcomes.

CONCLUSION

The modified primary closure method for reconstruction of the pelvic floor in LELAPE for low rectal cancer is technically feasible, safe and cost-effective.

Keywords: Extralevator abdominoperineal excision; Rectal cancer; Pelvic floor; Laparoscopy

Core tip: The modified primary closure approach requires laparoscopic closure of the pelvic peritoneum and layered closure of the perineal defect. By using this modified approach, the length of hospital stay and the total cost were decreased significantly, while other clinical outcomes did not differ, except for a relatively longer time for pelvic reconstruction (14.6 ± 3.7 min vs 7.2 ± 1.9 min). We conclude that the modified primary closure method for reconstruction of the pelvic floor in laparoscopic extralevator abdominal perineal excision for low rectal cancer is technically feasible, safe and cost-effective.