A Clinical Research About Pelvic Floor Reconstruction And Diverting Loop Ileostomy In Laparoscopic Low Anterior Resection For Rectal Cancer

Objective: This study aims to evaluate the efficacy of pelvic floor reconstruction and diverting loop ileostomy in laparoscopic low anterior resection for rectal cancer.Methods: We retrospectively reviewed 183 consecutive patients with rectal cancer who underwent laparoscopic low anterior resection from June2015 to June 2018 at The Second Affiliated Hospital of Chongqing Medical University.All of the cases are divided into 3 groups according to the diferences of surgical procedure.The 71 patients in group A underwent neither pelvic floor reconstruction nor diverting loop ileostomy,the 61 patients in group B underwent pelvic floor reconstruction and the 51 patients in group C underwent diverting loop ileostomy.These three groups were compared regarding general condition of patients,tumor's characteristics,hospital stay and costs,postoperative complications,etc.Results: Our study indicats that both diverting loop ileostomy andpelvic floor reconstruction cannot reduce the incidence of postoperative anastomotic leakage(group A 12.7% group B 13.1% group C 13.7%,P>0.05),but minimize the fatal consequences of anastomotic leakage,and decrease the rate of reoperation(group A 9.9% group B 1.6% group C 0%,P<0.05).In addition,these two procedures did not influence hospital stay(P>0.05)and costs(P>0.05),but the total hospital stay and costs increased due to the reversal surgery in group C(P<0.05).Unfortunately,4(8%)patients in group C suffered from stoma-related complications,and 19.6%of diverting loop ileostomy were not closed in group C because of local recurrence(7 cases),anastomotic-related complications(2 cases)and personal factors(1 case)----old age and fear of reoperation for closure.Conclusion: Both pelvic floor reconstruction and diverting loop ileostomy can minimise the fatal consequences of anastomotic leakage and decease the rate of reoperation in laparoscopic low anterior resection for rectal cancer,but diverting loop ileostomy is associated with another operation,a longer hospital stay,higher hospital costs and ostomy-related complications,even if a high rate of permanent stomas.In conclusion,pelvic floor reconstruction has significant value,and should be proposed during laparoscopic low anterior resection for rectal cancer.