The Clinical Application of Laparoscopic Extralevator Abdominoperineal Excision in Treatment of Low Rectal Cancer

［Abstract］Objective　To investigation the clinical effect of treatment for low rectal cancer by Laparoscopic extralevator abdominoperineal excision（LELAPE）. Method　We retrospectively analyzed the clinical data of 42 patients with low rectal cancer who underwent LELAPE from January 2013 to January 2016．Results This 42 cases all successfully completed the operation，The mean operative time（min）was 323.78 min（185～473），and the mean intraoperative blood loss（mL）was 168.81 mL（20～800）. No intestinal perforation and tumor perforation occurred during the operation，and no secondary injury occurred in the prostate, seminal vesicle gland，vagina，urethra and nerve. Circumferential resection margin （CRM）was negative in 41 cases（97.6%），positive in 1 case （2.4％），pelvic floor reconstruction in 39 cases（92.9%），and no pelvic floor reconstruction in 3 cases（7.1%）. Postoperative complications: intestinal obstruction due to small bowel falling into the pelvic floor occurred in 1 case of no pelvic floor reconstruction; dysfunction of urination occurred in 1 case, delayed healing due to fat liquefaction of perineal incisionoccurred in 4 cases（9.5%），includingn 2 cases complicated with pelvic effusion and infection （who received preoperative chemoradiotherapy during the same period）, the rest of the patients were healed; the time of postoperative removal of drainage tube was 10.9 days（6～20），the postoperative extubation time was 7 days （5-14）, the postoperative hospitalization time was 15.2 days（6-31）. Postoperative pathological staging：there was no cases of stage I, 20 cases of stage II（47.6%）， 21 cases of stage III（50%）， 1 case of stage IV（2.4%）. The postoperative follow up time was 3-36 months, there were 3 cases of local recurrence in perineal area, local the recurrence rate was 7.1%. Conclusion　LELAPE in surgical treatment of low rectal cancer can reduce the positive rate of CRM, the incidence of intraoperative secondary injury such as rectal perforation, the incidence of postoperative complications, reduce the postoperative local recurrence rate, which may improve the patient's prognosis and improve the survival rate of patients, so LELAPE in surgical treatment of low rectal cancer should be safe and feasible , and is worth further clinical application.