To compare the short‑term and long‑term outcomes of modified Bacon surgery (MBS) and immediate coloanal anastomosis (ICA) with protective loop ileostomy in the treatment of low rectal cancer. Methods The clinical data of 631 low rectal cancer patients undergoing laparoscopic proctectomy at the Department of Colorectal Surgery, the First Affiliated Hospital of Zhengzhou University between January 2015 and January 2023 was analyzed retrospectively and divided into MBS group and ICA group. Propensity score matching (PSM) was performed in a 1:1 ratio to balance baseline characteristics between the two groups. Post-matching comparisons were made with respect to the general information, operative-related indicators, postoperative complication rates and anal function. Kaplan-Meier survival curves were generated, and survival analysis was performed using the Log-rank test. Results 342 of 631 patients were successfully matched, including 171 cases in each group, respectively. After matching, no significant differences were observed in baseline characteristics between the two groups (all P>0.05). Compared with the ICA group, the MBS group exhibited shorter first operation time (170.2±13.7 min vs. 191.9±17.4 min, t=-12.821, P<0.001) and second operation time (45.3±5.0 min vs. 66.3±6.7 min, t=-32.693, P<0.001), lower postoperative pain scores ［3 (2, 3) vs. 5 (4, 5) after the first surgery (Z=-11.663, P<0.001) and 2 (2, 3) vs. 5 (4, 5) after the second-stage surgery (Z=-14.334, P<0.001)］, lower intraoperative blood loss during the second surgery ［10 (10, 15) mL vs. 15 (15, 20) mL, Z=-11.495, P<0.001］, lower total surgical costs ［(91 845±11 109) CNY vs. (110 838±8744) CNY, t=-17.568, P<0.001］, and a lower Clavien-Dindo grades of postoperative complications after the second surgery (Z=-2.193, P=0.028). However, no significant differences were found between the two groups in terms of blood loss during the first surgery, the incidence of postoperative complications after the first surgery, or anal function at 1 year postoperatively. Moreover, no significant differences were observed in the 3-year disease-free survival or overall survival between the two groups (χ²=0.285 and 0.208, P=0.593 and 0.648, respectively). Conclusion Modified Bacon surgery is a safe, minimally invasive, economical, and effective surgical procedure, which provides a stoma-sparing alternative for patients expecting anal preservation with low rectal cancer.
Key words
modified Bacon surgery /
low rectal cancer /
laparoscopy /
protective loop ileostomy
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