To investigate the clinical application of laparoscopic extralevator abdominoperineal excision(L-ELAPE) for the treatment of low rectal cancer.

The clinical data of 109 patients with low rectal cancer admitted to the 960th Hospital of the Joint Logistic Support Force of the People’s Liberation Army of China from May 2018 to May 2023 were retrospectively analyzed. Among them, sixty-nine patients who underwent L-ELAPE were assigned to the study group, and 40 patients who underwent traditional laparoscopic abdominoperineal excision(APE) were assigned to the control group. The general data before surgery, intraoperative observation indicators, postoperative recovery, long-term postoperative complications, and urogenital system scores of the two groups were compared and analyzed.

All 109 patients successfully completed their surgeries. The basic conditions of the patients in the study group and the control group, such as gender, age, distance from the tumor to the anal margin, body mass index(BMI), clinical stage, whether neoadjuvant therapy was applied, intraoperative lymph node dissection, postoperative recovery exhaust time, delayed healing of perineal incision, urinary dysfunction, severe pulmonary infection, postoperative TNM pathological stage, hospital stay and sexual dysfunction, showed no statistically significant difference (all P>0.05). The intraoperative blood loss[(136.86±52.53 mL vs. 215.40±70.21 mL), t=6.648, P=0.001]and the number of intraoperative perforations[4.34%(3/69) vs. 22.5(9/40), χ²=8.516, P=0.004], operation time(178.36±55.32 min vs. 142.47±36.53 min, t=3.663, P=0.001), positive rate of circumferential margin(CRM)[2.9%(2/69) vs. 15%(6/40), χ²=5.453, P=0.020], perineum long-term chronic pain[18.8%(13/69) vs. 2.9%(2/40), χ²=4.087, P=0.043)], chronic pain after caudal resection[28.6%(10/35) vs. 8.8%(3/34), χ²=4.398, P=0.036], local recurrence rate[4.3%(3/69) vs. 15%(6/40), χ²=3.793, P=0.050] differences exist statistical significance.

L-ELAPE surgery for advanced low rectal cancer can reduce the positive rate of CRM, intraoperative intestinal perforation and postoperative local recurrence rate. The occurrence of chronic perineal pain after surgery may be related to the resection of the coccyx during the operation. The application of biological patches for pelvic floor reconstruction is safe and feasible.Therefore, the L-ELAPE surgery is safe and effective and deserves further promotion and application.