Clinical application of ileal mesentery pelvic floor reconstruction in low rectal cancer surgery

JIANG Songsong; WANG Jiafeng; CHEN Gang

doi:10.3969/j.issn.1674-4136.2025.02.002

Abstract：Objective To investigate the safety and clinical efficacy of ileal mesentery pelvic floor reconstruction in resection of low advanced rectal cancer.Methods A retrospective analysis was conducted on the clinical efficacy of ileal mesentery pelvic floor reconstruction in 32 patients with low rectal cancer who underwent Miles,ELAPE,or Hartmann surgery in our hospital from January 2022 to April 2024.The surgical situation,postoperative complications,and prognosis follow-up of the patients were observed.Results 32 patients with low rectal cancer underwent Miles,ELAPE,or Hartmann surgery,in which ileal mesentery pelvic floor reconstruction was used.Among them,22 were male and 10 were female;The age range is 34 to 87 years old,with an average age of 68 years old.The distance between the lower edge of the tumor and the anal margin was 1 to 10 cm,with a median distance of 5 cm.In three cases,the pelvic floor peritoneum was sutured during surgery,resulting in intestinal obstruction.A second surgery was performed to reconstruct the pelvic floor using mesentery,and good therapeutic effects were achieved.The operation time ranged from 130 to 305 minutes(average 218 minutes),the postoperative drainage tube removal time is 6-13 days(average 10 days),and the hospitalization time is 10-35 days(average 19 days).Postoperative pathology showed that the upper and lower margins as well as the circumferential margin of the specimen were negative.The number of lymph nodes cleared ranged from 12-39,with an average of 18 lymph nodes cleared.Among them,there were 2 cases of high differentiation adenocarcinoma,26 cases of low differentiation adenocarcinoma,and 4 cases of low differentiation adenocarcinoma.Postoperative pathological staging:2 cases in stage Ⅰ,11 cases in stage Ⅱ,and 19 cases in stageⅢ.The average follow-up after surgery was 8 months,and all incisions healed in stageⅠwithout any incision infection,rupture,bulging,or intestinal obstruction.No local tumor recurrence or pelvic floor peritoneal hernia was found during the follow-up period.Conclusions Miles,ELAPE,or Hartmann surgery for low rectal cancer using ileal mesentery to reconstruct the pelvic floor can reduce the incidence of postoperative complications and has good clinical application value.