Safety and short-term outcomes of laparoscopic abdominoperineal resection with pelvic peritoneum closure for low rectal cancer

Objective To investigate the safety and short-term outcomes of laparoscopic abdominoperineal resection with pelvic peritoneum closure (LARP-PPC) for low rectal cancer. Methods The retrospective cohort study was conducted. The clinicopathological data of 132 patients with low rectal cancer who were admitted to Ruijin Hospital of Shanghai JiaoTong University School of Medicine from January 2014 to December 2017 were collected. There were 81 males and 51 females, aged from 45 to 83 years, with an average age of 62 years. Among the 132 patients, 60 undergoing LARP-PPC were allocated into LARP-PPC group, and 72 patients undergoing conventional LARP were allocated into LARP group. All the patients received standardized preoperative and postoperative treatments. Observation indicators: (1) surgical and postoperative conditions; (2) postoperative pathological examination; (3) postoperative complications. The measurement data with normal distribution were expressed as Mean±SD, and the t test was used for comparison between groups. The measurement data with skewed distribution were expressed as M (range), and the Mann-Whitney U test was used for comparison between groups. The count data were expressed as absolute numbers, and the chi-square test or the Fisher exact probability was used for comparison between groups. Mann-Whitney U test was used for comparison of ordinal data between groups. Results (1) Surgery and postoperative conditions: all the patients in the two groups underwent successful surgery without conversion to open surgery. The operation time, volume of intraoperative blood loss, time to first flatus, and time to first liquid intake of the LARP-PPC group were (163±45) minutes, 168 mL(range, 85-280 mL), 2 days(range, 1-5 days), 3 days(range, 2-6 days), versus (155±39) minutes, 160 mL(range, 100-305 mL), 3 days(range, 1-7 days), 4 days(range, 2-7 days) of the LARP group; there was no difference between the two group (t=1.113, Z=-1.623, -1.468, -0.321, P>0.05). The duration of postoperative hospital stay in the LARP-PPC group and the LARP group were 16 days(range, 11-21 days) and 19 days (14-24 days), respectively, with a significant difference between the two groups (Z=-5.888, P 0.05). (3) Postoperative complications: cases with perineal wound infection, delayed perineal wound healing, intestinal obstruction, and perineal hernia were 2, 1, 1, 0 in the LARP-PPC group, and 12, 10, 8, 6 in the LARP group, showing significant differences between the two groups (χ2=6.137, 6.400, P 0.05). Conclusion LARP-PPC is safe and feasible for the treatment of low rectal cancer, which can significantly reduce postoperative perineal-related complications and consequently shorten postoperative hospital stay. Key words: Rectal neoplasms; Low rectal cancer; Abdominoperineal resection; Perineal-specific complications; Pelvic peritoneum closure; Laparoscopy