To observe and evaluate the different clinical effects between laparoscopic assisted modified extralevator abdominoperineal excision (ELAPE) and abdominoperineal resection (APR) on low rectal cancer with resection of anus.

Prospective studies were conducted between December 2015 and June 2021. Sixty-eight patients with low rectal cancer were randomly assigned to modified laparoscopic assisted ELAPE surgery group and traditional laparoscopic APR surgery group, thirty-four patients for each. Then the clinical efficacy of different groups would be evaluated . The clinical and pathological parameters including operation time, blood loss, lymph nodes positive rate, perforation rate, positive rate of circumferential, exhaust time, defecation time, eating time, abdominal drainage flow, perineal incision suture-out time, pelvic drainage tube removal time and hospital stay; Postoperative complications included postoperative pelvic hemorrhage, intestinal obstruction, perineal incision infection, perineal incision hematoma and other rare complications. The follow-up results included local recurrence rate, distant metastasis rate and mortality.

The operation time in ELAPE group was significantly longer than that in APR group (t=5.490, P=0.000); There was no significant difference in intraoperative bleeding (t=-0.775, P=0.441), lymph node positive rate (χ²=0.553, P=0.457), positive rate of circumferential margin (χ²=0.863, P=0.353) and perforation rate; exhaust time (t=-4.403, P=0.000). The defecation time (t=-2.934, P=0.005) and perineal incision suture-out time (t=-2.490, P=0.015) in ELAPE group were earlier than those in APR group, the abdominal drainage flow less than APR group (t=3.524, P=0.001), the difference was statistically significant. There was no significant difference in the time of eating liquid food (t=0.593, P=0.555), pelvic drainage tube removal (t=1.581, P=0.122) and hospital stay (t=-1.465, P=0.148) between the two groups; There was no significant difference in postoperative pelvic hemorrhage (t=4.24, P=0.94), intestinal obstruction (t=5.55, P=0.58), perineal incision infection (t=7.74, P=0.54), perineal incision hematoma (t=8.55, P=0.14) and other rare complications (t=3.11, P=0.41) between the two groups. After follow-up for 6~66 months, the local recurrence rate (χ²=5.639, P=0.018) and distant metastasis rate (χ²=4.178, P=0.041) in ELAPE group were lower than those in APR group, the difference was statistically significant, and there was no significant difference in mortality between the two groups (χ²=2.601, P=0.107).

Compared with the traditional APR, the modified laparoscopic assisted ELAPE is a safer surgery, which can effectively reduce the local recurrence rate and distant metastasis rate, as well as accelerate the postoperative rehabilitation of patients. In our opinion, this surgical procedure is worth of recommendation.