Short‐term outcomes of pelvic floor peritoneum closure in endoscopic low anterior resection of rectal cancer: A propensity score matching analysis

Abstract

Background: The efficacy of pelvic floor peritoneum closure (PC) during endoscopic low anterior resection (E-LAR) of rectal cancer remains unclear. This study aimed to clarify whether pelvic floor PC affected short-term outcomes. Methods: The study group comprised patients with the pathologically confirmed diagnosis of rectal cancer who underwent E-LAR with pelvic floor PC or with no PC (NPC) between January 2013 and December 2018 in Southwest Hospital. After propensity score matching (PSM), 584 patients (292 who underwent PC and 292 who underwent NPC) were evaluated. Postoperative indicators, including the rates of complications, anastomotic leakage (AL), reoperation, and inflammation, were observed in the two groups. Results: No significant difference was observed in the rates of postoperative complications between the PC and NPC groups. The rates of AL were similar (11.3% vs. 9.2%, p = .414). However, the reoperation rate of patients in the PC group was significantly lower than that of patients in the NPC group after AL (36.4% vs. 11.1%, p = .025). The hospital costs were higher in the NPC leakage subgroup (p = .001). Additionally, the serum C-reactive protein levels were lower in the PC group on postoperative days (PODs) 1, 3, and 5, whereas procalcitonin levels on POD 1 and 3 were lower in the PC group but did not differ significantly on POD 5. Conclusion: Pelvic peritonization did not affect the rate of complications, especially AL; however, it effectively reduced the reoperation and inflammation rates and reduced hospitalization costs. Other short-term outcomes were similar, which warrant the increased use of pelvic peritonization in endoscopic surgery.

Pelvic Floor Peritoneum Closure Reduces Severe Postoperative Complications in Rectal Cancer Patients After Laparoscopic Anterior Rectal Resection

“…Since we routinely performed PC for rectal cancer patients who received LAR starting in 2017, the overall occurrence of postoperative AL in our study was about 4%, which is lower than the 6.3% to 13.7% reported in the literature. 13,14,17,18 The progression of AL depends on several factors, including age, sex, obesity, comorbidities, bowel preparation, nCRT, anastomotic level, pelvic drainage, operation time, blood transfusion, anastomotic blood supply and intestinal pressure. 14,[19][20][21][22][23] This data suggests that improving a single factor might not lead to an obvious change in the incidence of AL or other complications.…”

“…This helps prevent the leakage from progressing to grade C (ie, requiring anesthetized surgery), providing the opportunity to use conservative measures like medication, transanal tube drainage, and abscess puncture drainage instead of immediate reoperation. 13,24 Preventing the need for reoperation could reduce the trauma caused by anesthesia and operation, shorten hospital stays, and ensure on-schedule subsequent treatments like adjuvant chemoradiotherapy. In addition, PC might reduce radiation enteritis in patients receiving adjuvant radiotherapy.…”

“…10 Several studies have reported that PC can decrease the severe clinical effects of AL and prevent the incidence of diffuse peritonitis, thereby lowering the rate of reoperation. [10][11][12][13][14] However, whether PC can reduce the incidence of AL and other complications after LAR is still unclear. To the best of our knowledge, only a few studies have investigated the effect of PC in rectal cancer patients who received LAR during postsurgery complications.…”

“…To the best of our knowledge, only a few studies have investigated the effect of PC in rectal cancer patients who received LAR during postsurgery complications. 12,13 In this study, we performed a large-scale retrospective analysis of rectal cancer cases treated with LAR in our center, to compare the incidence of postsurgery complications between PC and non-PC groups.…”

Colorectal anastomosis in rectal cancer surgery: methods of anastomotic leakage prevention

“…В китайском журнале хирургической онкологии в 2020 г. были опубликованы результаты исследования, проведенного L. Chuan и соавт. с участием 584 пациентов, говорящие о том, что частота развития НА достоверно сопоставима в группах с ушиванием и без ушивания тазовой брюшины, но частота повторных операций по поводу НА в группе пациентов с ушиванием тазовой брюшины достоверно ниже (36,4 % против 11,1 %; р = 0,025) [55]. Еще одно китайское исследование с участием 189 пациентов показало, что ушивание тазовой брюшины не только снижает риск повторных операций, но и уменьшает частоту развития НА (р = 0,14) [56].…”