Do different methods of specimen extraction in laparoscopic low rectal cancer surgery affect loop ileostomy closure?

Abstract

Abstract Introduction: The aim of this study was to compare whether laparoscopic low rectal cancer surgery with three different specimen extraction methods affects loop ileostomy closure. Materials and methods: A consecutive series of patients with low rectal cancer who underwent laparoscopic low anterior resection plus protective loop ileostomy (LAR-PLI) were enrolled. Three main techniques, namely specimen extraction through auxiliary incision (EXAI), specimen extraction through stoma incision (EXSI), and specimen eversion and extra-abdominal resection (EVER), were employed. The postoperative outcomes of the three techniques and the impact on loop ileostomy closure were compared. Results: In all, 254 patients were enrolled in this study: 104 (40.9%) in the EXAI group, 104 (40.9%) in the EXSI group, and 46 (18.1%) in the EVER group. For primary surgery, EXAI group had significantly longer operative time (P<0.001), more intraoperative bleeding (P<0.001), longer length of abdominal incision (P＜0.001), longer time to first flatus (P<0.001), longer time to first defecation (P<0.001), longer time to first eat (P<0.001), and longer postoperative hospital stays (P=0.005) than the EXSI and EVER groups. The primary postoperative complication rate in the EXAI and EVER group was significantly higher than in the EXSI group (P=0.005). In loop ileostomy closure, EXAI group had significantly longer operative time (P=0.001), more bleeding volume and longer postoperative hospital stays (P<0.001) than the EXSI and EVER groups. Conclusions: All three techniques of LAR-PLI for low rectal cancer were safe and feasible, but specimen extraction via EXAI had no advantages in terms of early postoperative recovery and loop ileostomy closure.