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Is it worthwhile to perform closure of the pelvic peritoneum in laparoscopic extralevator abdominoperineal resection?

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Abstract

Purpose

There is no uniformity in the use of closure of the pelvic peritoneum (CPP) after laparoscopic extralevator abdominoperineal excision (ELAPE). This study aimed to evaluate the short-term outcomes of CPP after ELAPE and provide supporting evidence for the performance of CPP in laparoscopic ELAPE.

Methods

Patients with rectal cancer who underwent ELAPE from January 2014 to April 2019 were retrospectively investigated. CPP was routinely performed unless it was not feasible. The main outcome was the difference in the occurrence of perineal hernia (PH), small bowel obstruction (SBO) and perineal wound complications between laparoscopic and open ELAPE, which were compared using Kaplan–Meier curves.

Results

Of the 244 patients included, 104 received laparoscopic ELAPE, and 140 received open ELAPE. Patients in the laparoscopic group suffered a higher incidence of PH (11.5% (12/104) vs. 5.0% (7/140), p = 0.049), SBO (10.6% (11/104) vs. 7.9% (11/140), p = 0.433) and major perineal wound complications (12.5% (13/104) vs. 7.9% (11/140), p = 0.228) than those in the open group. Multivariate analysis showed that no-CPP was an independent risk factor for the occurrence of PH (p = 0.022, OR 3.436, 95% CI 1.199–9.848) and major perineal wound complications (p = 0.012, OR 3.683, 95% CI 1.337–10.146).

Conclusion

In this comparative cohort study with a risk of allocation bias, CPP was associated with a lower incidence of radiological PH and major perineal wound complications regardless of the surgical approach. Thus, we believe CPP could serve as an option L-ELAPE for the prevention of perineal complications. To further determine the impact of CPP on postoperative complications after ELAPE, a prospective multicentre study is needed.

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Data availability

The datasets used in the current study are available from the corresponding author upon reasonable request.

Code availability

Not applicable.

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Funding

The work is supported by the Department of Science and Technology of Sichuan Province (No. 2018RZ0091) and West China Hospital of Sichuan University (1·3·5 project of disciplines of excellence—Clinical Research Incubation Project, No. 2019HXFH031).

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Guo Xue Xiang 37#, Chengdu, Sichuan Province, China

    Yu Shen, Tinghan Yang, Wenjian Meng & Ziqiang Wang

  2. Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China

    Hanjiang Zeng

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  1. Yu Shen
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  2. Tinghan Yang
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  3. Hanjiang Zeng
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  4. Wenjian Meng
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Yu Shen, Tinghan Yang and Hanjiang Zeng. The first draft of the manuscript was written by Yu Shen, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ziqiang Wang.

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Ethics approval

This experiment was approved by the Biomedical Ethics Committee (BEC) of West China Hospital of Sichuan University (2019 No. 194).

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The authors declare no competing interests.

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Attributed to: West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Yu Shen and Tinghan Yang contributed equally to this work and should be considered co-first authors.

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Shen, Y., Yang, T., Zeng, H. et al. Is it worthwhile to perform closure of the pelvic peritoneum in laparoscopic extralevator abdominoperineal resection?. Langenbecks Arch Surg 407, 1139–1150 (2022). https://doi.org/10.1007/s00423-021-02412-5

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  • DOI: https://doi.org/10.1007/s00423-021-02412-5

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