Published online Aug 14, 2018. doi: 10.3748/wjg.v24.i30.3440
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
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.
To introduce a novel modified primary closure technique of LELAPE for low rectal cancer.
To assess the feasibility, safety and cost-effectiveness of the newly introduced technique by comparing it with the traditional method.
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.
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.
The modified primary closure method for reconstruction of the pelvic floor in LELAPE for low rectal cancer is technically feasible, safe and cost-effective.
Future multicentered randomized controlled trials should be performed to confirm the conclusions made in the present study.