The application of autologous tissue pelvic floor reconstruction in laparoscopic abdominoperineal resection combined radical resection of rectal cancer
ZHANG Kangkang
DONG Yonghong
GUO Wei
ZHAO Jinjiang
HE Zhipeng
LYU Weimin
ZHANG Xianglong
Abstract：Objective To reveal the benefits of using autologous tissue for pelvic floor reconstruction after laparoscopic transperineal resection(LAPR),and to share the surgical experience.Methods A retrospective analysis was conducted on 78 patients with low rectal cancer in our hospital from January 2022 to July 2024.Propensity score matching was used to match the initial data at a 1∶1 ratio,including 39 patients who did not undergo pelvic floor reconstruction(control group)and 39 patients who completed pelvic floor reconstruction using autologous tissue(observation group).All patients underwent postoperative intestinal function assessment,and defecation function was evaluated using the special scale for low anterior resection syndrome.The quality of life 6 months after the operation was evaluated by using the European Organization for Research and Treatment of Cancer(EORTC)Quality of Life Questionnaire-C30(QoQ-C30).In addition,record the short-term postoperative complications of the patients and the incidence of no events during the follow-up period.Results The time for the first liquid diet after surgery in the observation group was slightly shorter than that in the control group(P=0.043).Through repeated measures analysis of variance,with the extension of postoperative recovery time,the decrease in the low anterior resection syndrome score in the observation group was greater(F=66.984,P<0.001).Furthermore,at 6 months after the operation,20 cases(51.28%)in the control group and 7 cases(17.95%)in the observation group were diagnosed with low anterior resection syndrome,respectively(χ2=9.573,P=0.002).At 6 months after the operation,the total EORTC QoQ-C30 scores of the control group and the observation group were 66.67(58.33,75.0)points and 75.0(66.67,83.33)points respectively,and the difference between the two groups was statistically significant(Z=-2.951,P=0.003).The total number of postoperative complications in the control group and the observation group was 13 cases(33.33%)and 5 cases(12.82%)respectively.The difference between the two groups was statistically significant(χ2=4.622,P=0.032).No pelvic infection occurred in the observation group,while the incidence of pelvic abscess was significantly higher in the control group(15.38%vs.0,P=0.025).The average event-free survival time of the observation group was longer than that of the control group(not reached vs.31.29 months,P<0.001).Proximity to the anal margin,radiotherapy and anastomotic leakage are risk factors for the occurrence of low anterior resection syndrome 6 months after surgery,while autologous tissue pelvic floor reconstruction is a protective factor.Conclusion Autologous tissue pelvic floor reconstruction reduces the incidence of complications after LAPR in patients with low-risk rectal cancer,and improves the quality of life and prognosis of patients.
Keywords：Rectal cancerLaparoscopic transabdominal perineal combined resectionAutologous tissue pelvic floor reconstructionLow anterior resection syndrome
Publication Date：2025-09-28
Online Publishing Date：2025-10-28(First online date of this platform, not the publication date of the document)
Pages：6( 863-868 )