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Objective <p>To compare the impact of retromesenteric versus anterior mesenteric approaches on postoperative outcomes after laparoscopic radical resection for low rectal cancer.</p> Methods <p>This single-center retrospective cohort study included 157 patients (59 retromesenteric, 98 anterior mesenteric) treated between 2020 and 2023. Primary outcomes were postoperative inflammatory response, including C-reactive protein (CRP) and procalcitonin (PCT) levels on days 1, 3, and 7. Secondary outcomes included complications and recovery indicators. Logistic regression adjusted for confounders.</p> Results <p>Baseline characteristics were comparable. On postoperative day 1, CRP (68.4 ± 12.3 vs. 85.2 ± 14.7&#xa0;mg/L, <i>P</i> &lt; 0.01) and PCT (0.45 ± 0.08 vs. 0.61 ± 0.10 ng/mL, <i>P</i> &lt; 0.01) were significantly lower in the retromesenteric group, with similar trends on day 3. Anastomotic leakage was less frequent in the retromesenteric group (6.2% vs. 18.4%, <i>P</i> = 0.048), confirmed as an independent protective factor in multivariable logistic regression analysis (OR = 3.16, 95% CI: 1.009–9.894). No significant differences were observed in incisional infection, ileus, or intra-abdominal infection (<i>P</i> &gt; 0.05). Time to first flatus was shorter in the retromesenteric group (48.6 ± 6.3 vs. 52.3 ± 7.1&#xa0;h, <i>P</i> &lt; 0.01), while hospital stay and 30-day readmission rates were similar.</p> Conclusion <p>The retromesenteric approach is superior to the anterior mesenteric approach in reducing postoperative inflammatory reactions and the risk of anastomotic leakage, and promotes postoperative intestinal function recovery, which provides an important basis for the selection of surgical approaches for low rectal cancer.</p> Trial registration <p>Not applicable.</p>

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A single-center retrospective cohort study on the effects of different surgical routes on complications after radical resection of low rectal cancer

  • 期刊论文

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  • 发表日期：

    2025年12月26日

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  • Ruifeng Ye,
  • Weixin Wu,
  • Chongbiao Chen,
  • Long Yi,
  • Qin Gao

摘要

Objective

To compare the impact of retromesenteric versus anterior mesenteric approaches on postoperative outcomes after laparoscopic radical resection for low rectal cancer.

Methods

This single-center retrospective cohort study included 157 patients (59 retromesenteric, 98 anterior mesenteric) treated between 2020 and 2023. Primary outcomes were postoperative inflammatory response, including C-reactive protein (CRP) and procalcitonin (PCT) levels on days 1, 3, and 7. Secondary outcomes included complications and recovery indicators. Logistic regression adjusted for confounders.

Results

Baseline characteristics were comparable. On postoperative day 1, CRP (68.4 ± 12.3 vs. 85.2 ± 14.7 mg/L, P < 0.01) and PCT (0.45 ± 0.08 vs. 0.61 ± 0.10 ng/mL, P < 0.01) were significantly lower in the retromesenteric group, with similar trends on day 3. Anastomotic leakage was less frequent in the retromesenteric group (6.2% vs. 18.4%, P = 0.048), confirmed as an independent protective factor in multivariable logistic regression analysis (OR = 3.16, 95% CI: 1.009–9.894). No significant differences were observed in incisional infection, ileus, or intra-abdominal infection (P > 0.05). Time to first flatus was shorter in the retromesenteric group (48.6 ± 6.3 vs. 52.3 ± 7.1 h, P < 0.01), while hospital stay and 30-day readmission rates were similar.

Conclusion

The retromesenteric approach is superior to the anterior mesenteric approach in reducing postoperative inflammatory reactions and the risk of anastomotic leakage, and promotes postoperative intestinal function recovery, which provides an important basis for the selection of surgical approaches for low rectal cancer.

Trial registration

Not applicable.