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

Table 1 Study, procedure, and reconstruction characteristics, mean ± SD/median (interquartile range)

Ref.	Year	Design	Operation	Reconstruction approach	PC/control (n)	Age, PC/control	Male/female/PC/control
Yan et al[1]	2021	Retrospective cohort	LAPR	Primary pelvic peritoneal suture closure	86/96	61.42 ± 11.75/62.07±12.82	62/24/64/32
Shen et al[2]	2021	Retrospective cohort	LAPR/ELAPE	Primary pelvic peritoneal closure	79/21	58 (26-78)/62 (30–91)	47/32/10/11
Li et al[3]	2021	Retrospective PSM cohort	LAR	Primary pelvic peritoneal closure	292/292	59 ± 2.1/61 ± 1.9	161/131/168/124
Wang et al[4]	2018	Retrospective cohort	LAR (Dixon)	Pelvic peritonization by suture	92/97	62.23 ± 4.34/62.45 ± 4.89	56/36/60/37
Ji et al[5]	2022	Prospective cohort	LAR	Continuous barbed-suture reconstruction	58/172	58.4 ± 11.1/59.5 ± 11.0	35/23/105/67
Han et al[6]	2023	Retrospective cohort	LAR	Pelvic peritoneal reconstruction	48/49	61.25 ± 10.38/59.47 ± 11.40	29/19/27/22
Gao et al[7]	2021	Retrospective PSM cohort	LAR	Pelvic peritoneal reconstruction	153/153	61 (51-67)/60 (52-67)	100/53/99/54
Hultman et al[8]	2010	Retrospective cohort	APR/ELAPE	Pedicled omental flap reconstruction	29/41	59.9/57.8	Not reported
Li et al[9]	2025	Retrospective cohort	LAPR	Extraperitoneal colostomy + peritoneal closure	98/64	60.13 ± 10.09/62.09 ± 9.18	57/41/38/26
Shen et al[10]	2022	Retrospective cohort	LAPR/ELAPE	Primary pelvic peritoneal closure	82/22	Not reported	Not reported
Fu et al[11]	2024	Retrospective cohort	LAR	Pelvic floor peritoneal suture closure	401/717	58 (51-65)/59 (49-65)	268/133/460/257

Reconstruction approaches have been reported, as described in the source articles. PC: Pelvic floor peritoneal reconstruction; PSM: Propensity score matching; LAPR: Laparoscopic abdominoperineal resection; ELAPE: Extralevator abdominoperineal excision; LAR: Laparoscopic anterior resection.

Table 2 Quality evaluation of all the included studies

Ref.	Study design	NOS score (0-9)	Quality rating
Yan et al[1]	Retrospective cohort	6	Moderate
Shen et al[2]	Retrospective cohort	6	Moderate
Li et al[3]	Retrospective PSM cohort	7	High
Wang et al[4]	Retrospective cohort	6	Moderate
Ji et al[5]	Prospective cohort	7	High
Han et al[6]	Retrospective cohort	6	Moderate
Gao et al[7]	Retrospective PSM cohort	6	Moderate
Hultman et al[8]	Retrospective cohort	5	Moderate
Li et al[9]	Retrospective cohort	5	Moderate
Shen et al[10]	Retrospective cohort	7	High
Fu et al[11]	Retrospective cohort	7	High

PSM: Propensity score matching; NOS: Newcastle-Ottawa Scale. Scores of 7-9 were rated as high quality and 4-6 as moderate quality.

Table 3 Summary of main outcomes

Outcome	Studies	Procedure	Effect (95%CI)	Peffect	I2; Pheterogeneity	Model
Intestinal obstruction	9[1,2,4,6-11]	Overall	RR 0.30 (0.18-0.49)	< 0.001	0%; 0.52	Fixed
Intestinal obstruction	4[1,2,8,10]	LAPR/ELAPE	RR 0.25 (0.12-0.52)	< 0.001	0%; 0.85	Fixed
Intestinal obstruction	5[4,6,7,9,11]	LAR	RR 0.34 (0.17-0.70)	0.003	32%; 0.21	Fixed
Internal hernia	5[1,2,8-10]	Overall	RR 0.36 (0.17-0.79)	0.010	0%; 0.52	Fixed
Anastomotic leak	7[3-8,11]	Primarily LAR	RR 0.69 (0.51-0.93)	0.020	5%; 0.64	Fixed
Unplanned reoperation	6[1-3,7,8,11]	Overall	RR 0.33 (0.19-0.57)	< 0.001	0%; 0.52	Fixed
Unplanned reoperation	3[1,2,8]	LAPR/ELAPE	RR 0.40 (0.16-0.98)	0.046	38%; 0.20	Fixed
Unplanned reoperation	3[3,7,11]	LAR	RR 0.30 (0.15-0.60)	< 0.001	0%; 0.78	Fixed
Hospital stay	3[1,3,9]	Mixed	MD -2.40 (-4.33 to -0.47)	0.015	87%; < 0.001	Random

LAPR: Laparoscopic abdominoperineal resection; ELAPE: Extralevator abdominoperineal excision; LAR: Laparoscopic anterior resection; RR: Relative risk; MD: Mean differences.

Table 4 Grading of Recommendations Assessment, Development and Evaluation certainty of evidence

Outcome	Studies/participants	Design	Risk of bias	Inconsistency	Indirectness	Imprecision	Publication bias	Certainty
Intestinal obstruction	9/2328	Observational cohorts	Residual confounding	Not serious	Not serious	Not serious	Undetected; limited power	Low
Internal hernia	5/618	Observational cohorts	Residual confounding	Not serious	Not serious	Serious (sparse events)	Undetected; limited power	Very low
Anastomotic leak	7/2594	Observational cohorts	Residual confounding	Not serious	Serious (procedure-specific)	Serious	Undetected; limited power	Very low
Unplanned reoperation	6/2360	Observational cohorts	Residual confounding	Not serious	Not serious	Not serious	Undetected; limited power	Low
Hospital stay	3/928	Observational cohorts	Residual confounding	Serious (I2 = 87%)	Serious (care pathways)	Serious/unstable	Undetected; limited power	Very low

Observational evidence begins with low certainty. No reliable formal test for publication bias was possible because each outcome included fewer than ten studies.