Efficacy of Pelvic Peritoneal Reconstruction following Laparoscopic Abdomino-Perineal Resection of the Rectum in the treatment of Lower Rectal Cancer: A comparative Study and review

Abstract

Background: Laparoscopic abdominoperineal resection (LAPR) for rectal cancer poses a difficult challenge for surgeons regarding pelvic peritoneal reconstruction. Therefore, in this study, we investigate the effectiveness of pelvic peritoneal reconstruction following LAPR in the treatment of rectal cancer. Methods: We retrospectively reviewed clinical data records of patients who were treated with LAPR for rectal cancer in our hospital. Patients were included if they met predetermined inclusion criteria. All included patients were divided into two groups: group A (LAPR with pelvic peritoneum reconstruction (PPR) and group B (LAPR without PPR). For each included patients, following data were record: age, sex, body mass index (BMI), ASA score (American society of anesthesiologists), cancer staging, duration of operation, amount of blood loss, hospital stay, retrieved lymph nodes, time until start of flatus and oral intake and complications (early or late). Following endpoints were analyzed: operation time, intra-operative blood loss, and post-operative complication rate. Results: A total of 146 patients underwent LAPR including 48 patients with PPR (group A) and 98 patients without PPR (group B). LAPR procedures were successful in all included patients, with no patient requiring conversion to an open approach. The mean duration of follow-up was 12 months (range, 9 to 15 months) in both groups. There was significant difference in both groups regarding operation time, duration of hospital stay and follow up, and prevalence of late complications such as intestinal obstruction and tumour recurrence (p<0.05). No statistical difference was observed regarding demographic data, intra-operative blood loss and prevalence of early complications (p>0.05). Conclusion: LAPR technique is safe and effective procedure for patients with lower rectal cancer. Authors strongly recommend PPR following LAPR.