Pelvic floor peritoneum reconstruction is a protective factor for defecation dysfunction after laparoscopic anterior resection in patients with middle and low rectal cancer

• Published in: Surgery today (Tokyo, Japan) Japan), 2022-09, Vol.52 (9), p.1320-1328
• Main Authors: Ji, Liqiang, Li, Shuyuan, Xin, Cheng, Liu, Peng, Gong, Haifeng, Sui, Jinke, Lou, Zheng, Zhang, Wei
• Format: Article
• Language: English
• Subjects: Medicine; Medicine & Public Health; Original Article; Surgery; Surgical Oncology
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-021-02445-9

Purpose The pelvic cavity is a monolithic structure whose integrity plays an important role in the pelvic organ function. Currently, pelvic floor peritoneum reconstruction (PFPR) is rarely performed during laparoscopic surgery for middle and low rectal cancer patients. This study evaluated the effect of PFPR using barbed wire during laparoscopic surgery on the postoperative defecation function in middle and low rectal cancer patients. Methods This was a retrospective study involving a total of 252 middle and low rectal cancer patients who had been subjected to laparoscopic-assisted anterior resection of rectal cancer at Shanghai Changhai Hospital from March 2018 to April 2020. The Wexner and low anterior resection syndrome (LARS) scores were used to evaluate the postoperative defecation function among patients. A Wexner score ≥ 8 and LARS score ≥ 30 were considered to indicate major defecation dysfunction. Results A total of 229 patients (52 patients subjected to PFPR) were followed up, and the Wexner and LARS scores were recorded. The follow-up rate was 90.87%, the mean follow-up time was 22.88 ± 6.93 months, the stoma rate was 64.29%, the ileostomy reduction surgical rate was 90.74%, and the stoma duration was 7.64 ± 2.94 months. Regarding the assessment of postoperative defecation dysfunction using the Wexner score, a multivariate analysis revealed that a long operation time (odds ratio [OR], 0.991; 95% confidence interval [CI], 0.984–0.999, p  = 0.026) and radiotherapy (OR, 0.352; 95% CI, 0.156–0.797, p  = 0.012) were independent risk factors for major defecation dysfunction, while a high tumor location (OR, 1.318; 95% CI, 1.151–1.657, p  = 0.001) and PFPR (OR, 4.770; 95% CI, 1.435–15.857, p  = 0.011) were independent protective factors for major defecation dysfunction. Regarding the assessment of the postoperative defecation function using the LARS score, a multivariate analysis revealed that a high tumor location (OR, 1.293; 95% CI, 1.125–1.486, p