EP624 - Clinical Application Of Whole Pelvic Floor Resection In Combined Pelvic Organ Resection: A prospective Multicentre Descriptive Study From China

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Purpose/Background: Pelvic floor resection is an essential aspect of pelvic organ resection surgery. There is variability in the technical execution of pelvic floor excision and in short-term outcomes. Consequently, it is essential to investigate optimal treatment practices post-pelvic floor resection in specialized hospitals.

Methods/Interventions: This observational study on pelvic floor resection for locally advanced or recurrent rectal cancer in China was a prospective, multicenter descriptive investigation including three tertiary hospitals. Patients with locally advanced or locally recurrent rectal cancer, lacking pelvic or extrapelvic metastases or possessing only limited metastasis, are candidates for pelvic organ combination with en bloc pelvic floor resection surgery.

Results/Outcomes: Combined pelvic organ resection with whole pelvic floor resection was successfully completed in 82 patients, with an operating time of 480 (390-1020) min, intraoperative bleeding of 800 (200-3500) ml, and intraoperative blood transfusion of 1200 (400-4000) ml; R0 was resected in 68 cases (82.9%), R1 was resected in 14 cases (17.1%), and the anterior sacral -sacral nerve roots were removed Pelvic floor muscle was removed in 37 cases (45.1%), sacrum - sacrospinous ligament - sacrococcygeal ligament - internal obturator muscle - anterior and posterior pubic symphysis/pubic symphysis in 31 cases (37.8%), sciatico-rectal fossa - gluteus maximus muscle - extra-obturator tissues in 12 cases (14.7%), and skin - external genitalia in 2 cases (2.4%), and the procedure was completed in the lithotomy position in 65 cases (79.3%), and in lithotomy position+prone folding position. Surgery was completed in 17 cases (20.7%), reconstruction of pelvic floor by patch alone in 43 cases (52.4%), reconstruction of pelvic floor by patch + tipped greater omentum in 39 cases (47.6%), and reconstruction of the urinary tract in 36 cases (43.9%); time for recovery of intestinal function was 3.6 (2-7) d, time for drain removal was 29.4 (24-54) d, and time for healing of the empty pelvis was 36.2 (27-56) d. The number of patients who underwent surgery in the position of stone-blocking and prone folding knife was 2 cases (2.4%); ＜There were 67 (81.7%) cases of < grade III complications and 20 (24.4%) cases of ≥ grade III complications, with follow-up up to December 31, 2023 or case fatality, and the median follow-up time of 82 patients was 15.5 (0.5-30) months, and only 1 (1.2%) patient died during the perioperative period.

Conclusion/Discussion: The total pelvic floor excision technique is safe and feasible in combined pelvic organ resection surgeries, while also improving the R0 resection rate. Further studies are needed to explore the optimal technique for total pelvic floor excision in order to improve outcomes further.