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:
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.
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
Research background

Laparoscopic extralevator abdominal perineal excision (LELAPE) was introduced to reduce the rate of positive circumferential margins and intraoperative perforation, however its extensive dissection requires reconstruction of the pelvic floor.

Research motivation

To introduce a novel modified primary closure technique of LELAPE for low rectal cancer.

Research objectives

To assess the feasibility, safety and cost-effectiveness of the newly introduced technique by comparing it with the traditional method.

Research methods

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

Research results

The modified primary closure of the pelvic floor requires longer reconstruction time, but total operating time was not different compared with the biological mesh closure group. The postoperative length of hospital stay and the total cost were both less in the modified primary closure group. No differences in other perioperative data, long-term complications or oncological outcomes were observed.

Research conclusions

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

Research perspectives

Future multicentered randomized controlled trials should be performed to confirm the conclusions made in the present study.