Efficacy of pelvic floor peritoneal reconstruction after laparoscopic resection of middle and low rectal cancer: A meta-analysis

Abstract

BACKGROUND

The incidence of rectal cancer is increasing, and laparoscopic resection is being widely used as the treatment approach. However, postoperative complications remain common and adversely affect outcomes. Although pelvic floor peritoneal reconstruction has been proposed to reduce these complications, its effectiveness remains unclear with no consensus on its routine use in clinical practice.

AIM

To evaluate the efficacy of pelvic floor peritoneal reconstruction in laparoscopic rectal cancer resection, particularly its effect on postoperative complications.

METHODS

A systematic search of PubMed, the Cochrane Library, EMBASE, and MEDLINE was conducted for comparative observational studies on pelvic floor peritoneal reconstruction published between January 2010 and May 2025. Two reviewers independently screened the studies and extracted data. Because all eligible comparative studies were observational cohorts, methodological quality was evaluated using the Newcastle-Ottawa Scale, and the certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. Risk ratios (RRs) were pooled for dichotomous outcomes and mean differences (MDs) were calculated for hospital stay. Procedure-based subgroup and leave-one-out sensitivity analyses were performed when data permitted.

RESULTS

In total, 11 observational cohort studies involving 3,142 patients were included. Pelvic floor peritoneal reconstruction was associated with lower risks of intestinal obstruction (RR = 0.30, 95%CI: 0.18-0.49; P_effect < 0.001; I² = 0%, P_{heterogeneity} = 0.52), internal hernia (RR = 0.36, 95%CI: 0.17-0.79; P_effect = 0.010; I² = 0%, P_{heterogeneity} = 0.52), anastomotic leak (RR = 0.69, 95%CI: 0.51-0.93; P_effect = 0.020; I² = 5%, P_{heterogeneity} = 0.64), and unplanned reoperation (RR = 0.33, 95%CI: 0.19-0.57; P_effect < 0.001; I² = 0%, P_{heterogeneity} = 0.52). Hospital stay favored reconstruction (MD = -2.40 days, 95%CI: -4.33 to -0.47; P_effect = 0.015); however, heterogeneity was substantial (I² = 87%, P_{heterogeneity} < 0.001) and leave-one-out analyses were unstable.

CONCLUSION

Pelvic floor peritoneal reconstruction may be associated with fewer short-term complications after laparoscopic surgery for rectal cancer. The effect on hospital stay is uncertain because of the substantial heterogeneity and sensitivity of individual studies. Technique selection could not be determined from the available evidence.

Keywords: Pelvic floor peritoneal reconstruction; Pelvic peritoneal reconstruction; Rectal cancer; Malignant rectal tumors; Laparoscopic surgery; Meta-analysis

Core Tip: Pelvic floor peritoneal reconstruction is associated with lower pooled risks of intestinal obstruction, internal hernia, anastomotic leakage, and unplanned reoperations. Procedure-specific analyses did not detect a difference between laparoscopic abdominoperineal resection and laparoscopic anterior resection for intestinal obstruction or reoperation; however, the subgroups were small and should not be considered equivalent. The hospital stay estimates were heterogeneous and unstable, and the reconstruction techniques were not sufficiently standardized for comparative ranking. Accordingly, the findings support selective consideration and further prospective evaluation rather than routine use.