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Session: ePoster: Colon and Colorectal Cancer 6 (Sun225)

EP505 - Outcomes of Laparoscopic Versus Open Pelvic Reconstruction using Mucosa-removed Sigmoid Colonic Flap in Locally Advanced Rectal Cancer

Sunday, May 11, 2025
2:41 PM - 2:46 PM PT
Location: Monitor 6, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Kitrawee Jirathaniruangkit, MD

    Fellowship
    Chulalongkorn Colorectal Research Unit, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
    King Chulalongkorn Memorial Hospital
    Lumlukka, Pathum Thani, Thailand

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    View ePoster

    • Author(s)

  • SM

    Songphol Malakorn, MD

    Assistant Professor
    Chulalongkorn Colorectal Research Unit, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
    Bangkok, Krung Thep, Thailand

    Disclosure information not submitted.

    • Senior Author(s)

  • CS

    Chucheep Sahakitrungruang, MD, MSc

    Professor of Surgery
    Chulalongkorn Colorectal Research Unit, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
    Bangkok, Krung Thep, Thailand

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Kitrawee Jirathaniruangkit, MD: This individual has no financial relationships with ineligible companies.
Chucheep Sahakitrungruang, MD, MSc: This individual has no financial relationships with ineligible companies.
Purpose/Background: Pelvic exenteration for advanced rectal cancer creates significant dead space, necessitating reconstruction. While myocutaneous flaps are common, they can cause donor site complications. Mucosa-removed sigmoid colonic flaps offer a safe alternative, with advantages like ease of use, good vascularity, no donor site issues, and compatibility with minimally invasive surgery. This study compares laparoscopic versus open pelvic reconstruction using mucosa-removed colonic flaps.

Methods/Interventions: A 10-year retrospective cohort review (June 2014 - June 2024) was conducted at Chulalongkorn Hospital, including all advanced rectal cancer patients who underwent colonic flap reconstruction. Cases with intraoperative flap failure were excluded. Demographics and clinical data were analyzed. The primary outcome is flap-related complications. Secondary outcomes are 30 days complications, length of hospital stay, and oncologic safety.

Results/Outcomes: Of 63 patients undergoing mucosa-removed colonic flap reconstruction, 12 were excluded due to intraoperative flap failure. The open surgery group (N=32) had higher rates of previous surgery (81% vs 42%; p=0.04) and more advanced cT4 stage (94% vs 68%; p=0.03) compared to the laparoscopic group (N=19). No flap loss or perineal hernia occurred, but persistent fluid collection was observed in 10% of both groups. Laparoscopic surgery resulted in less intraoperative blood loss (797 vs 1323 ml; p=0.006). Both groups had comparable length of hospital stay (11 vs 11.5 days; p=0.24), 30-day complications (Clavien-Dindo grade III: 31% vs 28%; p=0.45), and R1 resection rates (16% vs 28%; p=0.5).

Conclusion/Discussion: Mucosa-removed colonic flaps for pelvic reconstruction show good flap viability and acceptable complications. Laparoscopic approach reduces intraoperative blood loss while maintaining oncologic safety.

Mucosa-removed sigmoid colonic flap reconstruction
Laparoscopic total pelvic exenteration with pelvic reconstruction using a mucosa-removed sigmoid colonic flap in a patient with recurrent rectal cancer.
A. After tumor extirpation, the pelvic dead space and the end of the harvested sigmoid flap are exposed.
B. Spatulation at the antimesenteric side of the sigmoid flap
C. Completion of mucosa-removed colonic flap
D. Securing the mucosa-removed colonic flap to the pelvic floor muscle

Two-year postoperative CT scan after pelvic reconstruction using mucosa-removed colonic flap
Two-year postoperative CT scan reveals patency of the colonic flap (arrow) without evidence of perineal hernia or any fluid collection in a patient with locally advanced rectal cancer, after laparoscopic total pelvic exenteration, bilateral pelvic lymph node dissection, and pelvic reconstruction with a mucosa-removed sigmoid colonic flap.
a. Sagittal view, b. Coronal view