Abstract:

Objective

To study the clinical application effect of the Marcille triangular approach in pelvic organ combined resection for locally advanced rectal cancer.

Methods

The clinical data of 18 patients with locally advanced rectal cancer who underwent pelvic organ combined resection from October 2020 to October 2023 were retrospectively selected. The perioperative indexes and postoperative complications of the patients were analyzed; the survival status of the patients was statistically analyzed through follow-up,and the data were analyzed using the statistical software SPSS22.0. Measurement data that conformed to the normal distribution, such as the operation time and intraoperative blood loss, were expressed as (), and the Kaplan-Meier method was applied to analyze the prognostic survival of the patients.

Results

All 18 patients successfully completed the pelvic organ combined resection, and there was no perioperative death. The average operation time was (420.7±52.6) min, the intraoperative blood loss was (780.4±80.2) ml, the first postoperative exhaust time was (3.2±0.5) d, and the hospital stay was (11.6±2.5) d. The involvement of adjacent organs was as follows: 8 cases of the cervix, 4 cases of the endometrium, 7 cases of the prostate, 5 cases of the bladder,and 6 cases of the seminal vesicles. Among them, there were 8 cases of well-differentiated carcinoma and 10 cases of moderately differentiated carcinoma. All patients underwent the treatment of the empty pelvic cavity with a basement membrane biological patch during the intraoperative reconstruction. Reproductive system reconstruction was performed in 5 cases, vascular reconstruction was performed in 1 case using an acellular bovine pericardium patch, ureteral reconstruction was performed in 2 cases, bladder substitution with the ileum was performed in 1 case, and suture repair was performed in 1 case. Postoperatively, there was 1 case of intestinal obstruction, 1 case of abdominal cavity infection, 1 case of lower extremity venous thrombosis, 1 case of urinary tract infection, 1 case of ischemia in the middle of the pelvis, 3 cases of perineal dead space infection,and 2 cases of presacral bleeding. All the above complications were cured after conservative treatment, and the total complication rate was 55.6%. According to the Kaplan-Meier survival analysis, the cumulative median survival time of the included patients at 3 years was 33.5 months, and the cumulative median disease-free survival time was 19.8 months.

Conclusion

The Marcille triangular approach is safe and feasible in pelvic organ combined resection for locally advanced rectal cancer, and it is recommended for clinical promotion and application.

Key words: Locally Advanced Rectal Tumor, Radical Resection of Rectal Carcinoma, Pelvic Exenteration, Triangle Of Marcille