Department of Gastrointestinal Surgery, Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Medical University Cancer Hospital, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China.
Tech Coloproctol. 2021 Dec;25(12):1291-1300. doi: 10.1007/s10151-021-02521-9. Epub 2021 Sep 28.
The greater omentum has played a unique biological role in regenerative surgery. The aim of our study was to alter the anterior sacral structure by filling the anterior sacral space with the greater omentum and evaluate its effect on the low anterior resection syndrome (LARS) after total mesorectal excision (TME) surgery for low rectal cancer.
We retrospectively collected clinical data of patients with primary low rectal cancer who underwent TME and ileostomy closure in our hospital from March 2018 to March 2020. Spearman correlation analysis was conducted to analyze the correlation between postoperative mesorectal fascia (MRF) thickness and LARS score. Subsequently, we prospectively used a tipped greater omental flap graft to reconstruct the anterior rectal sacral structures (MRF reconstruction) in 17 patients and compared LARS scores and rectal compliance (RC) at week 12 after closure of the ileostomy in both groups.
There were 47 patients with No-MRF reconstruction (31 males, mean age 60.68 ± 9.21 years) and 17 with MRF reconstruction (10 males, mean age 49.82 ± 14.74 years). Correlation analysis indicated that MRF thickness and RC were negatively correlated with LARS severity (p < 0.05). The LARS score of patients with MRF reconstruction at 12 weeks was significantly better than that of those with No-MRF reconstruction (32.97 ± 2.65 vs. 26.94 ± 1.52, p = 0.001), and the RC of MRF reconstruction were lower (2.80 ± 0.55 vs. 3.67 ± 0.38, p = 0.001). In addition, MRF reconstruction and No-MRF reconstruction have the similar incidence of postoperative complications (p = 0.156). No hemorrhage or necrosis of the greater omentum flap was observed in any of the patients.
Greater omentum flap transplantation can significantly improve the symptoms of LARS at 12 weeks after ileostomy closure and we expect it to become a new surgical procedure for the treatment of low rectal cancer.
大网膜在再生外科中发挥了独特的生物学作用。我们的研究目的是通过在前侧直肠系膜空间填充大网膜来改变前侧骶骨结构，并评估其对低位直肠癌全直肠系膜切除（TME）手术后低位前切除综合征（LARS）的影响。
我们回顾性收集了 2018 年 3 月至 2020 年 3 月在我院接受 TME 和回肠造口关闭的原发性低位直肠癌患者的临床资料。采用 Spearman 相关分析分析术后直肠系膜筋膜（MRF）厚度与 LARS 评分的相关性。随后，我们前瞻性地在 17 例患者中使用尖端大网膜瓣移植物重建前侧直肠骶骨结构（MRF 重建），并比较两组患者回肠造口关闭后 12 周的 LARS 评分和直肠顺应性（RC）。
无 MRF 重建组（31 例男性，平均年龄 60.68±9.21 岁）有 47 例，有 MRF 重建组（10 例男性，平均年龄 49.82±14.74 岁）有 17 例。相关性分析表明，MRF 厚度和 RC 与 LARS 严重程度呈负相关（p<0.05）。MRF 重建组患者 12 周时的 LARS 评分明显优于无 MRF 重建组（32.97±2.65 与 26.94±1.52，p=0.001），且 MRF 重建组的 RC 较低（2.80±0.55 与 3.67±0.38，p=0.001）。此外，MRF 重建和无 MRF 重建术后并发症的发生率相似（p=0.156）。没有观察到大网膜瓣移植物的出血或坏死。
大网膜瓣移植可显著改善回肠造口关闭后 12 周时的 LARS 症状，我们期望它成为治疗低位直肠癌的一种新手术方法。
