Research progress of pelvic floor reconstruction after extralevator abdominoperineal resection
Objective To analyze the advantages and disadvantages of pelvic floor reconstruction after ELAPE in recent years,and to provide guidance and help for related research on reducing the incidence of perineal complications caused by the huge pelvic floor defect caused by ELAPE in patients with low rectal cancer.Methods We searched PubMed,EMBASE,Medline,Science Citation Index,Web of Science,CNKI,Chinese Medical Journal Full-text Database and oth-er major medical databases for all studies published between January 2018 and January 2024 without any language restrictions.The following search terms were used as keywords:"levator abdominoperineal resection,abdominoperineal column resection,pelvic floor reconstruction,biological mesh,myocutaneous flap,pedicled omentum plasty,extralevator abdominoperineal excision,ELAPE,abdominoperineal resection,Low rectal cancer,perineal complications.Inclusion criteria:(1)Epidemiological characteristics of rectal cancer;(2)Main clinical treatment modalities for low rectal cancer;(3)Indications and surgical criteria for ELAPE surgery;(4)Influencing factors of perineal complications after ELAPE surgery;(5)Methods of pelvic floor tissue reconstruction;(6)methods and control studies of pelvic floor reconstruction after ELAPE surgery.Exclusion criteria:(1)conference,review;(2)similar or duplicate literature.Finally,55 litera-tures(32 in English and 23 in Chinese)were analyzed according to inclusion and exclusion criteria.Results The reported methods of pelvic floor reconstruction include primary closure,autologous or allogeneic tissue repair(myocutaneous flap repair,pedicled omentum plasty,biological mesh,etc.).Each method has its own advantages and disadvantages,and the recognized best method for pelvic floor repair is still unclear.In recent years,compared with other pelvic floor repair methods,there are relatively many reports on the application of biological mesh in pelvic floor repair.Biological mesh has the advantages of simple operation,saving operation time and reducing perineal complications.More and more scholars believe that the combination of multiple techniques can significantly improve the success rate of pelvic floor repair and re-duce the incidence of postoperative complications,which needs to be confirmed by more clinical samples.Conclusions Many factors should be considered in the selection of the method of pelvic floor reconstruction.In view of the impact of neoadjuvant therapy on pelvic peritoneum and perineal soft tissue,patients with low rectal cancer need to undergo individ-ualized ELAPE surgery.Therefore,it is necessary to choose the appropriate method of pelvic floor reconstruction accord-ing to the different intraoperative situations.
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